Skip to Content

Proposed Rule

Medicare Program; Proposed Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2006 Payment Rates; Correction

Document Details

Information about this document as published in the Federal Register.

Published Document

This document has been published in the Federal Register. Use the PDF linked in the document sidebar for the official electronic format.

Start Preamble Start Printed Page 50680

AGENCY:

Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION:

Proposed rule; correction.

SUMMARY:

This document corrects technical errors that appeared in the proposed rule published in the Federal Register on July 25, 2005 entitled “Medicare Program; Proposed Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2006 Payment Rates; Proposed Rule.”

Start Further Info

FOR FURTHER INFORMATION CONTACT:

Rebecca Kane, (410) 786-0378.

End Further Info End Preamble Start Supplemental Information

SUPPLEMENTARY INFORMATION:

I. Background

FR Doc. 05-14448 contains our proposed rule to update the Medicare Outpatient Prospective Payment System for calendar year (CY) 2006. We have identified a number of technical errors in the “Summary of Errors” section and are correcting them in the “Correction of Errors” section below.

II. Summary of Errors

A. Corrections Related to the Rural Adjustment Calculation

The calendar year (CY) 2006 Outpatient Prospective Payment System (OPPS) proposed rule that we published in the Federal Register on July 25, 2005 included a proposed 6.6 percent adjustment for rural sole community hospitals. The calculations used to develop the conversion factor and budget neutrality scalar inadvertently incorporated this adjustment as 6.4 percent. The rural adjustment is used in calculations that determine the scalar and conversion factor, and therefore affects the payment rates and copayment amounts published in the proposed rule. The corrected scalar is 1.003753831, and the corrected conversion factor is $59.343. The various changes to the preamble are specified under section III. of this correction notice. In addition to preamble text changes, we are correcting specific tables and addenda which also reflected the inadvertent use of a 6.4 percent rural adjustment factor, which we have described below.

On page 42709, we published Table 11. We are correcting the last column of this table to present the corrected proposed CY 2006 payment amounts. In section III. of this notice, we republish Table 11 as corrected.

On pages 42761-42762, we published Table 33. In section III. of this notice, we republish Table 33 as corrected.

On pages 42764-42775, we published Addendum A, which provides the payment rates and copayment amounts for Ambulatory Payment Classification (APC) groups used for payment purposes under the OPPS. A corrected Addendum A is posted on the OPPS Web site at http://www.cms.hhs.gov/​providers/​hopps/​2006p/​1501p.asp.

On pages 42776-42965, we published Addendum B, which provides the payment rates and copayment amounts for services payable under OPPS. A corrected Addendum B, including additional technical errors affecting HCPCS codes 78814, 78815, 78816, 91035, and 95950 is posted on the OPPS Web site at http://www.cms.hhs.gov/​providers/​hopps/​2006p/​1501p.asp.

We are posting the corrected Addendum A and Addendum B on our Web site rather than publishing them in this notice because of the large volume of data included in these addenda. Hard copies of these tables are available by contacting the CMS staff member identified above.

We note that as soon as we discovered these inadvertent errors that affected the payment rates noted in the proposed rule, we posted the corrections on the CMS Web site at: http://www.cms.hhs.gov/​providers/​hopps/​2006p/​1501p.asp.

B. Other Corrections

We also noted other typographical, formatting, and other technical errors in the proposed rule.

On page 42714, we published Table 15. The proposed “unadjusted” and “adjusted” CY 2006 APC median cost for APC 0085 Level II Electrophysiologic Evaluation contained a typographical error and should read $2,123.38. We are correcting this under section III. of this notice.

On page 42761, column 2 includes a comparison that discusses the differences in copayments from CY 2005 to CY 2006. While the analysis of this example is correct, the example incorrectly identifies the comparison as being the “minimum unadjusted copayment” rather than the “national unadjusted copayment”. We are making this correction under section III. of this notice to refer to the “national unadjusted copayment”.

On page 42737, we published Table 26, which inadvertently excluded C2636 (Brachytherapy linear source, Palladium -103, per 1 mm) which was accurately described in the text of page 42736 as a proposed separately payable brachytherapy source. In section III. of the notice we append the excluded row to correct table 26 as published.

The other technical, typographical, formatting, and other errors that appeared on various other pages of the Federal Register are corrected as noted in section III. of this notice.

III. Correction of Errors

In FR Doc. 05-14448 of July 25, 2005 (70 FR 42674), make the following corrections:

1. On page 42690, in column 3, in the last paragraph, in line 20, the figure “0.999207669” is corrected to read “1.003753831”.

2. On page 42691, in column 1, in the second full paragraph, line 8, the year “2006” is corrected to read “2007”.

3. On page 42694,

a. In column 1, in the second full paragraph, in line 8, the figure “$240.51” is corrected to read “$241.57”.

b. In column 1, in the second full paragraph, in line 8, the figure “$48.10” is corrected to read “$48.31”.

c. In column 3, in the third full paragraph, in line 8, the figure “1.002015212” is corrected to read “1.002023412”.

d. In column 3, in the third full paragraph, in line 18, the figure “0.99652023” is corrected to read “0.99639633”.

e. In column 3, in the last partial paragraph, in line 5, the figure “1.002015212” is corrected to read “1.002023412”.

4. On page 42695,

a. In column 1, in the first partial paragraph, in line 5, the figure “0.99652023” is corrected to read “0.99639633”.

b. In column 1, in the first partial paragraph, in line 7, the figure “$59.350” is corrected to read “$59.343”.

5. On page 42703,

a. In column 1, in the second full paragraph, in line 5, the figure “$9.95” is corrected to read “$7.00”.

b. In column 1, in the second full paragraph, in line 5, the figure “40” is corrected to read “28”.

c. In column 1, in the second full paragraph, in line 6, the figure “$24.89” is corrected to read “$25.00”.

6. On page 42709,Start Printed Page 50681

a. In column 1, in the first full paragraph, in line 22, the figure “$1,297” is corrected to read “$1,274”.

b. In column 1, in the first full paragraph, in line 23, the figure “$1,366” is corrected to read “$1,244”.

c. In column 1, in the first full paragraph, in line 25, the figure “$1,100” is corrected to read “$1,025”.

d. Table 11 is corrected to read as follows:

Table 11.—Proposed APC Reassignment of New Technology Procedures Into Clinical APCs for CY 2006

HCPCSDescriptorCY 2005 APCCY 2005 status indicatorProposed CY 2006 APCProposed CY 2006 status indicatorCY 2005 payment amountProposed CY 2006 payment amount
0027TEndoscopic epidural lysis1547T0220T$850$1,030.11
33225L ventric pacing lead add-on1525S0418T3,7506,486.45
61623Endovasc tempory vessel occl1555T0081T1,6502,044.21
92974Cath place, cardio brachytx1559T0103T2,250873.18
93580Transcath closure of asd1559T0434T2,2505,387.61
93581Transcath closure of vsd1559T0434T2,2505,387.61
95965Meg, spontaneous1528S0430T5,250676.75
95966Meg, evoked, single1516S0430T1,450676.75
95967Meg, evoked, each add'l1511S0430T950676.75
C9713Non-contact laser vap prosta1525S0429T3,7502,511.08

7. On page 42710, in column 2, in the first full paragraph, in line 19, the figure “$93.71” is corrected to read “$93.37”.

8. On page 42714, Table 15, APC 0085, in columns 5 and 7, in row 7, both occurrences of the figure “$2,123.46” are corrected to read “$2,123.38”.

9. On page 42737, Table 26, “Proposed Separately payable Brachytherapy Sources for CY 2006” is appended with the following row:

HCPCSLong descriptorAPCAPC titleNew status indicator
C2636Brachytherapy linear source, Palladium-103, per 1mm2636Brachytx linear source, P-103H

10. On page 42756, in column 1, in the first partial paragraph, in line 5, the figure “1.8” is corrected to read “1.7”.

11. On page 42758, in column 2, in the third full paragraph, in line 13, the figure “$59.35” is corrected to read “$59.34”.

12. On page 42759,

a. In column 1, in the first partial paragraph, in line 21, the figure “5.8” is corrected to read “5.6”.

b. In column 1, in the first partial paragraph, in line 31, the figure “1.2” is corrected to read “1.3”.

c. In column 1, in the first partial paragraph, in line 31, the figure “1.8” is corrected to read “1.7”.

d. In column 1, in the first partial paragraph, in line 36, the figure “2.6” is corrected to read “2.5”.

e. In column 1, in the second partial paragraph, in line 22, the figure “2.9” is corrected to read “2.7”.

f. In column 1, in the second partial paragraph, in line 25, the figure “0.7” is corrected to read “0.6”.

g. In column 1, in the second partial paragraph, in line 30, the text “West South Central” is corrected to read “New England”.

h. In column 2, in the first partial paragraph, in line 2, the figure “1.9” is corrected to read “1.7”.

i. In column 2, in the first partial paragraph, in line 2, the figure “1.8” is corrected to read “1.6”.

j. In column 2, in the first full paragraph, in line 4, the figure “0.4” is corrected to read “0.3”.

k. In column 2, in the first full paragraph, in line 5, the figure “0.5” is corrected to read “0.3”.

l. In column 2, in the first full paragraph, in line 9, the figure “0.9” is corrected to read “1.6”.

m. In column 2, in the first full paragraph, in line 10, the figure “1.4” is corrected to read “2.2”.

n. In column 2, in the first full paragraph, in line 21, the sentence portion “1.3 percent and voluntary and government hospitals will gain at least 0.1 percent.” is corrected to read “1.1 percent, voluntary hospitals would gain 0.2 percent, and government hospitals will see no changes as a result of changes to APC structure.”

o. In column 3, in the second full paragraph, in line 7, the figure “0.997” is corrected to read “0.996”.

p. In column 3, in the second full paragraph, in line 10, the figure “0.3” is corrected to read “0.4”.

q. In column 3, in the second full paragraph, in line 13, the figure “5.2” is corrected to read “5.4”.

13. On page 42760,

a. In column 1, in the first partial paragraph, in line 6, the figure “0.3” is corrected to read “0.4”.

b. In column 1, in the first full paragraph, in line 19, the figure “5.8” is corrected to read “5.6”.

c. In column 1, in the first full paragraph, in line 24, the figure “-2.8” is corrected to read “-2.4”.

d. In column 1, in the first full paragraph, in line 32, the figure “1.2” is corrected to read “1.3”.

e. In column 1, in the first full paragraph, in line 35, the figure “0.3” is corrected to read “0.4”.

f. In column 1, in the first full paragraph, in line 37, the figure “1.5” is corrected to read “1.4”.

g. In column 1, in the last paragraph, in line 7, the figure “8.6” is corrected to read “8.7”.

h. In column 1, in the third partial paragraph, in line 12, the figure “5.0” is corrected to read “4.7”.

i. In column 3, in the first partial paragraph, in line 6, the figure “2.6” is corrected to read “2.5”.

j. In column 3, in the first partial paragraph, in line 12, the figure “2.1” is corrected to read “1.8”.

k. In column 3, in the first partial paragraph, in line 32, the figure “3.7” is corrected to read “3.6”.Start Printed Page 50682

l. In column 3, in the first full paragraph, in line 11, the figure “3.4” is corrected to read “3.5”.

m. In column 3, in the first full paragraph, in line 13, the figure “6.4” is corrected to read “6.5”.

n. In column 3, in the first full paragraph, in line 30, the text “greater than” is corrected to read “of at least”.

o. In column 3, in the first full paragraph, in lines 33 and 34, the figure “only 1.0” is corrected to read “1.4” and the text “and 0.8 percent, respectively.” is appended to the end of the sentence.

14. On page 42761

a. In column 1, in the first partial paragraph, in line 3, the figure “1.9” is corrected to read “2.6”.

b. In column 1, in the first partial paragraph, in line 6, the figure “2.6” is corrected to read “3.4”.

c. In column 1, in the first partial paragraph, in line 11, the figure “0.8” is corrected to read “0.6”.

d. In column 1, in line 12, the designation for the heading “Estimated Impacts of This Proposed Rule on Beneficiaries” is corrected from “G” to read “F”.

e. In column 1, in the second partial paragraph, in line 12, the figure “$11.86” is corrected to read “$11.91”.

f. In column 2, in the first partial paragraph, in lines 4 and 6, the term “minimum” is corrected to read “national”.

g. In column 2, in the first partial paragraph, in line 8, the figure “$223.91” is corrected to read “$224.91”.

h. Table 33 is corrected to read as follows:

Table 33.—Impact of Proposed Changes for CY 2006 Hospital Outpatient Prospective Payment System

Hospital categoryNumber of hospitalsAPC changesNew wage indexNew adj for rural sole community hospitalsCumulative (Cols 2,3,4) with market basket updateAll changes
(1)(2)(3)(4)(5)(6)
ALL HOSPITALS42120.00.00.03.21.9
URBAN HOSPITALS29490.00.0−0.42.81.6
LARGE URBAN1624−0.80.0−0.42.00.8
OTHER URBAN13251.00.0−0.43.82.5
RURAL HOSPITALS1263−0.10.11.85.03.5
SOLE COMMUNITY478−0.10.05.48.76.5
OTHER RURAL785−0.10.1−0.42.81.6
BEDS (URBAN):
0-99 BEDS9170.00.2−0.43.02.1
100-199 BEDS964−0.40.0−0.42.51.5
200-299 BEDS5030.20.1−0.43.22.4
300-499 BEDS402−0.1−0.1−0.42.61.5
500 + BEDS1630.30.0−0.43.11.0
BEDS (RURAL):
0-49 BEDS551−0.90.22.14.63.1
50-100 BEDS419−0.80.22.34.83.0
101-149 BEDS1801.40.01.15.84.7
150-199 BEDS62−0.2−0.21.84.73.7
200 + BEDS510.10.01.75.13.1
VOLUME (URBAN):
LT 5,000 claim lines600−5.60.5−0.4−2.4−1.8
5,000-10,999180−2.40.2−0.40.50.6
11,000-20,999299−0.60.2−0.42.42.5
21,000-42,999575−0.60.1−0.42.31.9
GT 42,99912950.20.0−0.43.01.6
VOLUME (RURAL):
LT 5,000 claim lines119−2.70.01.41.71.4
5,000-10,999195−1.90.02.13.42.4
11,000-20,999325−0.9−0.12.04.33.4
21,000-42,999364−0.90.21.94.53.0
GT 42,9992600.60.01.75.73.8
REGION (URBAN):
NEW ENGLAND166−1.3−0.1−0.41.4−0.2
MIDDLE ATLANTIC3930.6−0.1−0.43.42.1
SOUTH ATLANTIC453−0.4−0.4−0.42.01.0
EAST NORTH CENT4660.4−0.1−0.43.21.7
EAST SOUTH CENT1971.50.0−0.44.43.4
WEST NORTH CENT1842.5−0.3−0.45.13.6
WEST SOUTH CENT445−0.3−0.1−0.42.51.3
MOUNTAIN163−0.1−0.2−0.42.51.3
PACIFIC431−1.71.1−0.42.21.4
PUERTO RICO510.4−0.3−0.42.92.2
REGION (RURAL):
NEW ENGLAND37−1.10.91.24.20.8
MIDDLE ATLANTIC781.7−0.41.46.04.1
SOUTH ATLANTIC189−0.4−0.21.74.43.3
EAST NORTH CENT171−0.60.11.44.12.2
EAST SOUTH CENT202−0.70.50.53.53.0
WEST NORTH CENT1881.6−0.32.67.24.7
Start Printed Page 50683
WEST SOUTH CENT242−0.9−0.22.24.43.7
MOUNTAIN95−1.00.14.67.05.2
PACIFIC61−0.71.82.77.25.3
TEACHING STATUS:
NON-TEACHING3115−0.30.10.33.22.3
MINOR7690.30.0−0.23.32.3
MAJOR3280.3−0.2−0.33.00.6
DSH PATIENT PERCENT:
0160.30.0−0.43.13.1
GT 0-0.103860.1−0.2−0.32.81.7
0.10-0.165550.00.10.23.52.4
0.16-0.238020.10.00.13.52.3
0.23-0.359770.1−0.10.03.21.9
GE 0.35792−0.30.1−0.13.01.8
TEFRA: DSH NOT AVAIL 1684−1.60.0−0.41.2−2.6
URBAN TEACHING/DSH:
TEACHING & DSH9440.4−0.1−0.43.11.7
NO TEACHING/DSH1401−0.30.1−0.42.51.8
NO TEACHING/NO DSH160.30.0−0.43.13.1
TEFRA: DSH NOT AVAIL 1588−2.20.1−0.40.7−3.4
TYPE OF OWNERSHIP:
VOLUNTARY23970.20.00.03.32.0
PROPRIETARY1091−1.10.00.02.11.6
GOVERNMENT7240.00.10.23.61.7
Col (1) Total Hospitals in 2006.
Col (2) This column shows the impact of changes resulting from the reclassification of HCPCS codes among APC groups and from the addition of multiple procedure discounting for radiology procedures (budget neutral overall).
Col (3) This column shows the adjustment for updating the wage index (budget neutral overall).
Col (4) This column shows the adjustment for rural sole community hospitals (budget neutral overall).
Col (5) This column shows the cumulative impact of cols 2 through 4 and the addition of the market basket update.
Col (6) The column shows the impact of the change in MMA dollars in 2006 (drugs and 508) and outlier changes.
1 Complete DSH numbers are not available for hospitals that are not paid under IPPS.

15. On pages 42764-42775, Addendum A is corrected to read as follows:

Start Printed Page 50684

Addendum A.—List of Ambulatory Payment Classifications (APCs) with Status Indicators, Relative Weights, Payment Rates, and Copayment Amounts Calendar Year 2006

APCGroup titleSIRelative weightPayment rateNational unadjusted copaymentMinimum unadjusted copayment
0001Level I PhotochemotherapyS0.4213$25.00$7.00$5.00
0002Level I Fine Needle Biopsy/AspirationT0.9559$56.73$11.35
0003Bone Marrow Biopsy/AspirationT2.6530$157.44$31.49
0004Level I Needle Biopsy/ Aspiration Except Bone MarrowT1.7646$104.72$22.36$20.94
0005Level II Needle Biopsy/Aspiration Except Bone MarrowT3.5994$213.60$71.59$42.72
0006Level I Incision & DrainageT1.5500$91.98$22.28$18.40
0007Level II Incision & DrainageT11.4501$679.48$135.90
0008Level III Incision and DrainageT16.4989$979.09$195.82
0009Nail ProceduresT0.6680$39.64$8.34$7.93
0010Level I Destruction of LesionT0.5719$33.94$9.65$6.79
0011Level II Destruction of LesionT2.0839$123.66$25.17$24.73
0012Level I Debridement & DestructionT0.8497$50.42$11.18$10.08
0013Level II Debridement & DestructionT1.1078$65.74$14.20$13.15
0015Level III Debridement & DestructionT1.6514$98.00$20.29$19.60
0016Level IV Debridement & DestructionT2.5834$153.31$33.57$30.66
0017Level VI Debridement & DestructionT18.4211$1,093.16$227.84$218.63
0018Biopsy of Skin/Puncture of LesionT1.1726$69.59$16.04$13.92
0019Level I Excision/ BiopsyT4.0547$240.62$71.87$48.12
0020Level II Excision/ BiopsyT6.9433$412.04$107.40$82.41
0021Level III Excision/ BiopsyT14.9776$888.82$219.48$177.76
0022Level IV Excision/ BiopsyT19.6472$1,165.92$354.45$233.18
0023Exploration Penetrating WoundT4.7775$283.51$56.70
0024Level I Skin RepairT1.6084$95.45$31.25$19.09
0025Level II Skin RepairT5.4938$326.02$101.85$65.20
0027Level IV Skin RepairT18.4182$1,092.99$329.72$218.60
0028Level I Breast SurgeryT19.5801$1,161.94$303.74$232.39
0029Level II Breast SurgeryT32.0476$1,901.80$632.64$380.36
0030Level III Breast SurgeryT40.0825$2,378.62$763.55$475.72
0033Partial HospitalizationP4.0708$241.57$48.31
0035Venous CutdownT0.7158$42.48$8.50
0036Level II Fine Needle Biopsy/AspirationT2.1773$129.21$25.84
0037Level IV Needle Biopsy/Aspiration Except Bone MarrowT9.4751$562.28$224.91$112.46
0039Level I Implantation of NeurostimulatorS181.4000$10,764.82$2,152.96
0040Level I Implantation of Neurostimulator ElectrodesS55.3297$3,283.43$656.69
0041Level I ArthroscopyT28.1318$1,669.43$333.89
0042Level II ArthroscopyT43.9753$2,609.63$804.74$521.93
0043Closed Treatment Fracture Finger/Toe/TrunkT1.7694$105.00$21.00
0045Bone/Joint Manipulation Under AnesthesiaT14.4945$860.15$268.47$172.03
0046Open/Percutaneous Treatment Fracture or DislocationT37.7023$2,237.37$535.76$447.47
0047Arthroplasty without ProsthesisT31.6107$1,875.87$537.03$375.17
0048Level I Arthroplasty with ProsthesisT43.1288$2,559.39$570.30$511.88
0049Level I Musculoskeletal Procedures Except Hand and FootT20.3707$1,208.86$241.77
0050Level II Musculoskeletal Procedures Except Hand and FootT23.9081$1,418.78$283.76
0051Level III Musculoskeletal Procedures Except Hand and FootT36.5271$2,167.63$433.53
0052Level IV Musculoskeletal Procedures Except Hand and FootT43.9378$2,607.40$521.48
0053Level I Hand Musculoskeletal ProceduresT15.6795$930.47$253.49$186.09
0054Level II Hand Musculoskeletal ProceduresT25.3711$1,505.60$301.12
0055Level I Foot Musculoskeletal ProceduresT20.0692$1,190.97$355.34$238.19
0056Level II Foot Musculoskeletal ProceduresT40.2957$2,391.27$478.25
0057Bunion ProceduresT27.5493$1,634.86$475.91$326.97
0058Level I Strapping and Cast ApplicationS1.0934$64.89$12.98
0060Manipulation TherapyS0.4935$29.29$5.86
0068CPAP InitiationS1.2293$72.95$29.18$14.59
0069ThoracoscopyT30.6775$1,820.49$591.64$364.10
0070Thoracentesis/Lavage ProceduresT3.2101$190.50$38.10
0071Level I Endoscopy Upper AirwayT0.7915$46.97$11.31$9.39
0072Level II Endoscopy Upper AirwayT1.4361$85.22$21.27$17.04
0074Level IV Endoscopy Upper AirwayT15.7757$936.18$295.70$187.24
0075Level V Endoscopy Upper AirwayT21.3426$1,266.53$445.92$253.31
0076Level I Endoscopy Lower AirwayT9.4592$561.34$189.82$112.27
0077Level I Pulmonary TreatmentS0.3444$20.44$7.74$4.09
0078Level II Pulmonary TreatmentS1.0236$60.74$14.55$12.15
0079Ventilation Initiation and ManagementS2.3482$139.35$27.87
0080Diagnostic Cardiac CatheterizationT37.1361$2,203.77$838.92$440.75
0081Non-Coronary Angioplasty or AtherectomyT34.4473$2,044.21$408.84
0082Coronary AtherectomyT85.0126$5,044.90$1,085.20$1,008.98
0083Coronary Angioplasty and Percutaneous ValvuloplastyT50.8925$3,020.11$604.02
0084Level I Electrophysiologic EvaluationS10.0205$594.65$118.93
0085Level II Electrophysiologic EvaluationT35.1882$2,088.17$426.25$417.63
Start Printed Page 50685
0086Ablate Heart Dysrhythm FocusT44.2596$2,626.50$833.33$525.30
0087Cardiac Electrophysiologic Recording/MappingT30.7101$1,822.43$364.49
0088ThrombectomyT36.5617$2,169.68$655.22$433.94
0089Insertion/Replacement of Permanent Pacemaker and ElectrodesT105.6143$6,267.47$1,682.28$1,253.49
0090Insertion/Replacement of Pacemaker Pulse GeneratorT89.1574$5,290.87$1,612.80$1,058.17
0091Level II Vascular LigationT28.9999$1,720.94$348.23$344.19
0092Level I Vascular LigationT23.4516$1,391.69$278.34
0093Vascular Reconstruction/Fistula Repair without Device
0094Level I Resuscitation and CardioversionS2.5363$150.51$47.62$30.10
0095Cardiac RehabilitationS0.5885$34.92$13.96$6.98
0096Non-Invasive Vascular StudiesS1.6307$96.77$38.70$19.35
0097Cardiac and Ambulatory Blood Pressure MonitoringX1.0223$60.67$23.79$12.13
0098Injection of Sclerosing SolutionT1.1346$67.33$13.47
0099ElectrocardiogramsS0.3821$22.67$4.53
0100Cardiac Stress TestsX2.4968$148.17$41.44$29.63
0101Tilt Table EvaluationS4.2787$253.91$101.56$50.78
0103Miscellaneous Vascular ProceduresT14.7142$873.18$223.63$174.64
0104Transcatheter Placement of Intracoronary StentsT79.0094$4,688.65$937.73
0105Revision/Removal of Pacemakers, AICD, or VascularT22.3685$1,327.41$370.40$265.48
0106Insertion/Replacement/Repair of Pacemaker and/or ElectrodesT45.4851$2,699.22$539.84
0107Insertion of Cardioverter-DefibrillatorT260.0295$15,430.93$3,103.22$3,086.19
0108Insertion/Replacement/Repair of Cardioverter-Defibrillator LeadsT349.1681$20,720.68$4,144.14
0109Removal of Implanted DevicesT11.0433$655.34$131.49$131.07
0110TransfusionS3.6594$217.16$43.43
0111Blood Product ExchangeS12.3956$735.59$200.18$147.12
0112Apheresis, Photopheresis, and PlasmapheresisS26.7948$1,590.08$438.94$318.02
0113Excision Lymphatic SystemT21.4653$1,273.82$254.76
0114Thyroid/Lymphadenectomy ProceduresT40.7652$2,419.13$485.91$483.83
0115Cannula/Access Device ProceduresT31.4727$1,867.68$459.35$373.54
0116Chemotherapy Administration by Other Technique Except InfusionS1.1453$67.97$13.59
0117Chemotherapy Administration by Infusion OnlyS3.2378$192.14$42.54$38.43
0120Infusion Therapy Except ChemotherapyS2.0193$119.83$28.21$23.97
0121Level I Tube changes and RepositioningT2.2766$135.10$43.80$27.02
0122Level II Tube changes and RepositioningT6.9721$413.75$84.85$82.75
0123Bone Marrow Harvesting and Bone Marrow/Stem Cell TransplantS22.9902$1,364.31$272.86
0125Refilling of Infusion PumpT1.9331$114.72$22.94
0130Level I LaparoscopyT31.9271$1,894.65$659.53$378.93
0131Level II LaparoscopyT43.3389$2,571.86$1,001.89$514.37
0132Level III LaparoscopyT62.9914$3,738.10$1,239.22$747.62
0140Esophageal Dilation without EndoscopyT5.4737$324.83$94.18$64.97
0141Level I Upper GI ProceduresT8.1835$485.63$143.38$97.13
0142Small Intestine EndoscopyT9.3487$554.78$152.78$110.96
0143Lower GI EndoscopyT8.6869$515.51$186.06$103.10
0146Level I Sigmoidoscopy and AnoscopyT4.6374$275.20$64.40$55.04
0147Level II Sigmoidoscopy and AnoscopyT7.9679$472.84$94.57
0148Level I Anal/Rectal ProceduresT3.7383$221.84$57.21$44.37
0149Level III Anal/Rectal ProceduresT18.0726$1,072.48$293.06$214.50
0150Level IV Anal/Rectal ProceduresT23.8654$1,416.24$437.12$283.25
0151Endoscopic Retrograde Cholangio-Pancreatography (ERCP)T18.7338$1,111.72$245.46$222.34
0152Level I Percutaneous Abdominal and Biliary ProceduresT12.2833$728.93$145.79
0153Peritoneal and Abdominal ProceduresT21.6961$1,287.51$382.75$257.50
0154Hernia/Hydrocele ProceduresT28.7847$1,708.17$464.85$341.63
0155Level II Anal/Rectal ProceduresT16.2546$964.60$192.92
0156Level II Urinary and Anal ProceduresT2.5751$152.81$40.52$30.56
0157Colorectal Cancer Screening: Barium EnemaS2.2904$135.92$27.18
0158Colorectal Cancer Screening: ColonoscopyT7.6588$454.50$113.63
0159Colorectal Cancer Screening: Flexible SigmoidoscopyS3.1455$186.66$46.67
0160Level I Cystourethroscopy and other Genitourinary ProceduresT6.6753$396.13$105.06$79.23
0161Level II Cystourethroscopy and other Genitourinary ProceduresT18.5576$1,101.26$249.36$220.25
0162Level III Cystourethroscopy and other Genitourinary ProceduresT23.3918$1,388.14$277.63
0163Level IV Cystourethroscopy and other Genitourinary ProceduresT33.7354$2,001.96$400.39
0164Level I Urinary and Anal ProceduresT1.1855$70.35$17.29$14.07
Start Printed Page 50686
0165Level III Urinary and Anal ProceduresT16.6689$989.18$197.84
0166Level I Urethral ProceduresT17.6743$1,048.85$218.73$209.77
0168Level II Urethral ProceduresT28.2685$1,677.54$388.03$335.51
0169LithotripsyT43.0133$2,552.54$1,021.01$510.51
0170DialysisS5.8994$350.09$70.02
0180CircumcisionT19.8827$1,179.90$304.87$235.98
0181Penile ProceduresT30.8663$1,831.70$621.82$366.34
0183Testes/Epididymis ProceduresT23.6415$1,402.96$280.59
0184Prostate BiopsyT4.3566$258.53$96.27$51.71
0188Level II Female Reproductive ProcT1.1400$67.65$13.53
0189Level III Female Reproductive ProcT2.3710$140.70$28.14
0190Level I HysteroscopyT21.0653$1,250.08$424.28$250.02
0191Level I Female Reproductive ProcT0.1670$9.91$2.78$1.98
0192Level IV Female Reproductive ProcT4.3082$255.66$51.13
0193Level V Female Reproductive ProcT14.5843$865.48$173.10
0194Level VIII Female Reproductive ProcT20.7525$1,231.52$397.84$246.30
0195Level IX Female Reproductive ProcT26.6791$1,583.22$483.80$316.64
0196Dilation and CurettageT17.0974$1,014.61$338.23$202.92
0197Infertility ProceduresT2.3572$139.88$27.98
0198Pregnancy and Neonatal Care ProceduresT1.3683$81.20$32.19$16.24
0200Level VII Female Reproductive ProcT17.8728$1,060.63$263.69$212.13
0201Level VI Female Reproductive ProcT17.6047$1,044.72$329.65$208.94
0202Level X Female Reproductive ProcT40.3866$2,396.66$958.66$479.33
0203Level IV Nerve InjectionsT10.4015$617.26$246.90$123.45
0204Level I Nerve InjectionsT2.1910$130.02$40.13$26.00
0206Level II Nerve InjectionsT5.4920$325.91$75.55$65.18
0207Level III Nerve InjectionsT6.0109$356.70$86.92$71.34
0208Laminotomies and LaminectomiesT42.3409$2,512.64$502.53
0209Extended EEG Studies and Sleep Studies, Level IIS11.5713$686.68$274.67$137.34
0212Nervous System InjectionsT2.9740$176.49$70.59$35.30
0213Extended EEG Studies and Sleep Studies, Level IS2.2932$136.09$54.43$27.22
0214ElectroencephalogramS1.1353$67.37$26.94$13.47
0215Level I Nerve and Muscle TestsS0.6115$36.29$14.51$7.26
0216Level III Nerve and Muscle TestsS2.6720$158.56$31.71
0218Level II Nerve and Muscle TestsS1.1408$67.70$13.54
0220Level I Nerve ProceduresT17.3586$1,030.11$206.02
0221Level II Nerve ProceduresT29.9209$1,775.60$463.62$355.12
0222Implantation of Neurological DeviceT179.0982$10,628.22$2,125.64
0223Implantation or Revision of Pain Management CatheterT28.1230$1,668.90$333.78
0224Implantation of Reservoir/Pump/ShuntT40.6455$2,412.03$482.41
0225Level II Implantation of Neurostimulator ElectrodesS234.6925$13,927.36$2,785.47
0226Implantation of Drug Infusion ReservoirT138.8695$8,240.93$1,648.19
0227Implantation of Drug Infusion DeviceT136.4922$8,099.86$1,619.97
0228Creation of Lumbar Subarachnoid ShuntT51.7258$3,069.56$613.91
0229Transcatherter Placement of Intravascular ShuntsT64.4545$3,824.92$771.23$764.98
0230Level I Eye Tests & TreatmentsS0.7858$46.63$14.97$9.33
0231Level III Eye Tests & TreatmentsS1.9278$114.40$44.61$22.88
0232Level I Anterior Segment Eye ProceduresT6.6732$396.01$103.17$79.20
0233Level II Anterior Segment Eye ProceduresT14.9673$888.20$266.33$177.64
0234Level III Anterior Segment Eye ProceduresT21.9741$1,304.01$511.31$260.80
0235Level I Posterior Segment Eye ProceduresT4.6593$276.50$67.40$55.30
0236Level II Posterior Segment Eye ProceduresT17.0229$1,010.19$202.04
0237Level III Posterior Segment Eye ProceduresT28.9401$1,717.39$343.48
0238Level I Repair and Plastic Eye ProceduresT2.5933$153.89$30.78
0239Level II Repair and Plastic Eye ProceduresT6.9097$410.04$82.01
0240Level III Repair and Plastic Eye ProceduresT18.1508$1,077.12$315.31$215.42
0241Level IV Repair and Plastic Eye ProceduresT23.3036$1,382.91$384.47$276.58
0242Level V Repair and Plastic Eye ProceduresT30.5464$1,812.72$597.36$362.54
0243Strabismus/Muscle ProceduresT22.1671$1,315.46$431.39$263.09
0244Corneal TransplantT38.3723$2,277.13$803.26$455.43
0245Level I Cataract Procedures without IOL InsertT13.3625$792.97$221.89$158.59
0246Cataract Procedures with IOL InsertT23.4597$1,392.17$495.96$278.43
0247Laser Eye Procedures Except RetinalT5.0330$298.67$104.31$59.73
0248Laser Retinal ProceduresT4.6769$277.54$93.98$55.51
0249Level II Cataract Procedures without IOL InsertT27.9369$1,657.86$524.67$331.57
0250Nasal Cauterization/PackingT1.2896$76.53$26.79$15.31
0251Level I ENT ProceduresT2.0101$119.29$23.86
0252Level II ENT ProceduresT7.8673$466.87$113.41$93.37
0253Level III ENT ProceduresT16.1357$957.54$282.29$191.51
Start Printed Page 50687
0254Level IV ENT ProceduresT23.4040$1,388.86$321.35$277.77
0256Level V ENT ProceduresT37.3204$2,214.70$442.94
0258Tonsil and Adenoid ProceduresT22.2466$1,320.18$437.25$264.04
0259Level VI ENT ProceduresT366.3317$21,739.22$8,070.21$4,347.84
0260Level I Plain Film Except TeethX0.7555$44.83$17.93$8.97
0261Level II Plain Film Except Teeth Including Bone Density MeasurementX1.2901$76.56$15.31
0262Plain Film of TeethX0.9228$54.76$10.95
0263Level I Miscellaneous Radiology ProceduresX1.7476$103.71$24.40$20.74
0264Level II Miscellaneous Radiology ProceduresX3.5240$209.12$79.41$41.82
0265Level I Diagnostic UltrasoundS1.0213$60.61$24.24$12.12
0266Level II Diagnostic UltrasoundS1.6393$97.28$38.91$19.46
0267Level III Diagnostic UltrasoundS2.6327$156.23$62.18$31.25
0268Ultrasound Guidance ProceduresS1.0610$62.96$12.59
0269Level III Echocardiogram Except TransesophagealS3.2437$192.49$76.99$38.50
0270Transesophageal EchocardiogramS6.0192$357.20$142.88$71.44
0272Level I FluoroscopyX1.3801$81.90$32.76$16.38
0274MyelographyS3.0413$180.48$72.19$36.10
0275ArthrographyS3.5779$212.32$69.09$42.46
0276Level I Digestive RadiologyS1.5319$90.91$36.36$18.18
0277Level II Digestive RadiologyS2.3852$141.54$56.61$28.31
0278Diagnostic UrographyS2.6434$156.87$62.74$31.37
0279Level II Angiography and Venography except ExtremityS8.9319$530.05$150.03$106.01
0280Level III Angiography and Venography except ExtremityS20.7902$1,233.75$353.85$246.75
0282Miscellaneous Computerized Axial TomographyS1.6542$98.17$39.26$19.63
0283Computerized Axial Tomography with Contrast MaterialS4.4253$262.61$105.04$52.52
0284Magnetic Resonance Imaging and Magnetic Resonance Angiography with ContrasS6.4201$380.99$152.39$76.20
0285Myocardial Positron Emission Tomography (PET)S17.1798$1,019.50$318.72$203.90
0288Bone Density: Axial SkeletonS1.2568$74.58$14.92
0296Level I Therapeutic Radiologic ProceduresS2.2452$133.24$53.29$26.65
0297Level II Therapeutic Radiologic ProceduresS5.2530$311.73$122.13$62.35
0299Miscellaneous Radiation TreatmentS5.8482$347.05$69.41
0300Level I Radiation TherapyS1.5198$90.19$18.04
0301Level II Radiation TherapyS2.2195$131.71$26.34
0302Level III Radiation TherapyS4.6145$273.84$103.74$54.77
0303Treatment Device ConstructionX2.8356$168.27$66.95$33.65
0304Level I Therapeutic Radiation Treatment PreparationX1.7738$105.26$41.52$21.05
0305Level II Therapeutic Radiation Treatment PreparationX4.0036$237.59$91.38$47.52
0310Level III Therapeutic Radiation Treatment PreparationX13.9490$827.78$325.27$165.56
0312Radioelement ApplicationsS5.0032$296.90$59.38
0313BrachytherapyS12.8655$763.48$152.70
0314Hyperthermic TherapiesS5.9945$355.73$98.36$71.15
0315Level II Implantation of NeurostimulatorT290.6470$17,247.86$3,449.57
0320Electroconvulsive TherapyS5.3765$319.06$80.06$63.81
0321Biofeedback and Other TrainingS1.3579$80.58$21.71$16.12
0322Brief Individual PsychotherapyS1.2319$73.10$14.62
0323Extended Individual PsychotherapyS1.6227$96.30$20.08$19.26
0324Family PsychotherapyS2.0997$124.60$24.92
0325Group PsychotherapyS1.3189$78.27$17.10$15.65
0330Dental ProceduresS7.1756$425.82$85.16
0332Computerized Axial Tomography and Computerized Angiography without ContrasS3.2694$194.02$77.60$38.80
0333Computerized Axial Tomography and Computerized Angio w/o Contrast MaterialS5.2836$313.54$125.41$62.71
0335Magnetic Resonance Imaging, MiscellaneousS5.1581$306.10$122.43$61.22
0336Magnetic Resonance Imaging and Magnetic Resonance Angiography without ContS6.0742$360.46$144.18$72.09
0337MRI and Magnetic Resonance Angiography without Contrast Material followedS8.7945$521.89$208.75$104.38
0339ObservationS7.1403$423.73$84.75
0340Minor Ancillary ProceduresX0.6384$37.88$7.58
0341Skin TestsX0.1112$6.60$2.62$1.32
0342Level I PathologyX0.1560$9.26$3.70$1.85
0343Level III PathologyX0.4786$28.40$11.10$5.68
0344Level IV PathologyX0.7996$47.45$15.66$9.49
0345Level I Transfusion Laboratory ProceduresX0.2277$13.51$3.01$2.70
0346Level II Transfusion Laboratory ProceduresX0.3434$20.38$4.54$4.08
0347Level III Transfusion Laboratory ProceduresX0.8434$50.05$12.35$10.01
Start Printed Page 50688
0348Fertility Laboratory ProceduresX0.7927$47.04$9.41
0350Administration of flu and PPV vaccinesX0.3954$23.46$0.00$0.00
0352Level I InjectionsX0.1413$8.39$1.68
0353Level II InjectionsX0.3954$23.46$4.69
0359Level III InjectionsX0.8312$49.33$9.87
0360Level I Alimentary TestsX1.4739$87.47$34.98$17.49
0361Level II Alimentary TestsX3.6216$214.92$83.23$42.98
0362Contact Lens and Spectacle ServicesX2.6607$157.89$31.58
0363Level I Otorhinolaryngologic Function TestsX0.9128$54.17$17.44$10.83
0364Level I AudiometryX0.4708$27.94$9.06$5.59
0365Level II AudiometryX1.2356$73.32$18.95$14.66
0366Level III AudiometryX1.7743$105.29$30.04$21.06
0367Level I Pulmonary TestX0.6659$39.52$14.80$7.90
0368Level II Pulmonary TestsX0.9761$57.92$23.16$11.58
0369Level III Pulmonary TestsX2.7519$163.31$44.18$32.66
0370Allergy TestsX1.1232$66.65$13.33
0372Therapeutic PhlebotomyX0.5700$33.83$10.09$6.77
0373Neuropsychological TestingX2.1926$130.12$26.02
0374Monitoring Psychiatric DrugsX1.0414$61.80$12.36
0375Ancillary Outpatient Services When Patient ExpiresT42.5900$2,527.42$505.48
0376Level II Cardiac ImagingS5.1975$308.44$121.42$61.69
0377Level III Cardiac ImagingS6.8344$405.57$162.22$81.11
0378Level II Pulmonary ImagingS5.4997$326.37$130.54$65.27
0379Injection adenosineK$33.45$6.69
0381Single Allergy TestsX0.1884$11.18$2.35$2.24
0384GI Procedures with StentsT22.3392$1,325.68$287.93$265.14
0385Level I Prosthetic Urological ProceduresS75.6446$4,488.98$897.80
0386Level II Prosthetic Urological ProceduresS120.1694$7,131.21$1,426.24
0387Level II HysteroscopyT32.5445$1,931.29$655.55$386.26
0388DiscographyS12.3294$731.66$292.66$146.33
0389Non-imaging Nuclear MedicineS1.4976$88.87$35.54$17.77
0390Level I Endocrine ImagingS2.5562$151.69$60.67$30.34
0391Level II Endocrine ImagingS2.8774$170.75$68.30$34.15
0393Red Cell/Plasma StudiesS3.4438$204.37$81.74$40.87
0394Hepatobiliary ImagingS4.4630$264.85$105.93$52.97
0395GI Tract ImagingS3.8699$229.65$91.86$45.93
0396Bone ImagingS4.1426$245.83$98.33$49.17
0397Vascular ImagingS2.2646$134.39$53.75$26.88
0398Level I Cardiac ImagingS4.3093$255.73$102.29$51.15
0399Nuclear Medicine Add-on ImagingS1.5192$90.15$36.06$18.03
0400Hematopoietic ImagingS4.1335$245.29$98.11$49.06
0401Level I Pulmonary ImagingS3.4150$202.66$81.06$40.53
0402Brain ImagingS5.1847$307.68$123.07$61.54
0403CSF ImagingS3.6138$214.45$85.78$42.89
0404Renal and Genitourinary Studies Level IS3.8559$228.82$91.52$45.76
0405Renal and Genitourinary Studies Level IIS4.2674$253.24$101.29$50.65
0406Tumor/Infection ImagingS4.3035$255.38$102.15$51.08
0407Radionuclide TherapyS3.9839$236.42$94.56$47.28
0409Red Blood Cell TestsX0.1258$7.47$2.22$1.49
0411Respiratory ProceduresS0.3869$22.96$4.59
0412IMRT Treatment DeliveryS5.3643$318.33$63.67
0415Level II Endoscopy Lower AirwayT22.0955$1,311.21$459.92$262.24
0416Level I Intravascular and Intracardiac Ultrasound and Flow ReserveS19.5542$1,160.40$232.08
0417Computerized ReconstructionS4.0750$241.82$48.36
0418Insertion of Left Ventricular Pacing ElectT109.3043$6,486.45$1,297.29
0421Prolonged Physiologic MonitoringX1.6600$98.51$19.70
0422Level II Upper GI ProceduresT22.9647$1,362.79$448.81$272.56
0423Level II Percutaneous Abdominal and Biliary ProceduresT40.2866$2,390.73$478.15
0425Level II Arthroplasty with ProsthesisT100.2058$5,946.51$1,378.01$1,189.30
0426Level II Strapping and Cast ApplicationS2.1243$126.06$25.21
0427Level III Tube Changes and RepositioningT10.1977$605.16$124.11$121.03
0428Level III Sigmoidoscopy and AnoscopyT19.9022$1,181.06$236.21
0429Level V Cystourethroscopy and other Genitourinary ProceduresT42.3147$2,511.08$502.22
0430Level IV Nerve and Muscle TestsT11.4040$676.75$135.35
0432Health and Behavior ServicesS0.6949$41.24$8.25
0433Level II PathologyX0.2581$15.32$6.12$3.06
0434Cardiac Defect RepairT90.7877$5,387.61$1,077.52
Start Printed Page 50689
0600Low Level Clinic VisitsV0.8688$51.56$10.31
0601Mid Level Clinic VisitsV1.0038$59.57$11.91
0602High Level Clinic VisitsV1.4284$84.77$16.95
0610Low Level Emergency VisitsV1.2947$76.83$19.48$15.37
0611Mid Level Emergency VisitsV2.2718$134.82$35.76$26.96
0612High Level Emergency VisitsV3.9853$236.50$54.12$47.30
0620Critical CareS8.2996$492.52$135.68$98.50
0621Level I Vascular Access ProceduresT8.2986$492.46$98.49
0622Level II Vascular Access ProceduresT21.2671$1,262.05$252.41
0623Level III Vascular Access ProceduresT27.1105$1,608.82$321.76
0648Breast Reconstruction with ProsthesisT50.4459$2,993.61$598.72
0651Complex Interstitial Radiation Source ApplicationS12.1448$720.71$144.14
0652Insertion of Intraperitoneal CathetersT28.8948$1,714.70$342.94
0653Vascular Reconstruction/Fistula Repair with DeviceT30.5339$1,811.97$362.39
0654Insertion/Replacement of a permanent dual chamber pacemakerT100.9294$5,989.45$1,197.89
0655Insertion/Replacement/Conversion of a permanent dual chamber pacemakerT133.7768$7,938.72$1,587.74
0656Transcatheter Placement of Intracoronary Drug-Eluting StentsT109.9237$6,523.20$1,304.64
0657Placement of Tissue ClipsS1.7092$101.43$20.29
0658Percutaneous Breast BiopsiesT6.1049$362.28$72.46
0659Hyperbaric OxygenS1.5473$91.82$18.36
0660Level II Otorhinolaryngologic Function TestsX1.6419$97.44$30.66$19.49
0661Level V PathologyX3.3775$200.43$80.17$40.09
0662CT AngiographyS5.1621$306.33$122.53$61.27
0664Level I Proton Beam Radiation TherapyS12.9439$768.13$153.63
0665Bone Density: AppendicularSkeletonS0.6464$38.36$7.67
0667Level II Proton Beam Radiation TherapyS15.4857$918.97$183.79
0668Level I Angiography and Venography except ExtremityS6.5024$385.87$114.67$77.17
0670Level II Intravascular and Intracardiac Ultrasound and Flow ReserveS25.4131$1,508.09$472.46$301.62
0671Level II Echocardiogram Except TransesophagealS1.7028$101.05$40.42$20.21
0672Level IV Posterior Segment Eye ProceduresT36.9284$2,191.44$438.29
0673Level IV Anterior Segment Eye ProceduresT29.2582$1,736.27$649.56$347.25
0674Prostate CryoablationT95.7856$5,684.20$1,136.84
0675Prostatic ThermotherapyT43.7329$2,595.24$519.05
0676Thrombolysis and ThrombectomyT2.4105$143.05$28.61
0678External CounterpulsationT1.7276$102.52$20.50
0679Level II Resuscitation and CardioversionS5.5774$330.98$95.30$66.20
0680Insertion of Patient Activated Event RecordersS62.9082$3,733.16$746.63
0681Knee ArthroplastyT137.1630$8,139.66$2,081.48$1,627.93
0682Level V Debridement & DestructionT6.9107$410.10$162.42$82.02
0683Level II PhotochemotherapyS1.9006$112.79$25.34$22.56
0685Level III Needle Biopsy/Aspiration Except Bone MarrowT6.0174$357.09$115.47$71.42
0686Level III Skin RepairT13.8287$820.64$164.13
0687Revision/Removal of Neurostimulator ElectrodesT19.2347$1,141.44$456.57$228.29
0688Revision/Removal of Neurostimulator Pulse Generator ReceiverT43.0444$2,554.38$1,021.75$510.88
0689Electronic Analysis of Cardioverter-defibrillatorsS0.5735$34.03$6.81
0690Electronic Analysis of Pacemakers and other Cardiac DevicesS0.3755$22.28$8.91$4.46
0691Electronic Analysis of Programmable Shunts/PumpsS2.5252$149.85$59.94$29.97
0692Electronic Analysis of Neurostimulator Pulse GeneratorsS2.0111$119.34$30.16$23.87
0693Level II Breast ReconstructionT42.2254$2,505.78$798.17$501.16
0694Mohs SurgeryT3.8452$228.19$61.86$45.64
0695Level VII Debridement & DestructionT20.3164$1,205.64$266.59$241.13
0697Level I Echocardiogram Except TransesophagealS1.5357$91.13$36.45$18.23
0698Level II Eye Tests & TreatmentsS1.2438$73.81$16.55$14.76
0699Level IV Eye Tests & TreatmentsT10.0177$594.48$118.90
0700Antepartum ManipulationT5.3614$318.16$63.63
0701SR 89 chloride, per mCiH
0702SM 153 lexidronamH
0704IN 111 Satumomab pendetide per doseH
0705Technetium TC99M tetrofosminH
0726Dexrazoxane hcl injectionK$216.39$43.28
0728Filgrastim injectionK$178.39$35.68
0730Pamidronate disodiumK$58.42$11.68
0731Sargramostim injectionK$21.11$4.22
0732Mesna injectionK$13.68$2.74
0733Non esrd epoetin alpha injK$9.99$2.00
Start Printed Page 50690
0734Injection, darbepoetin alfa (for non-ESRD)K$3.28$0.66
0735Ampho b cholesteryl sulfateK$12.24$2.45
0736Amphotericin b liposome injK$21.91$4.38
0737Ammonia N-13, per doseH
0738RasburicaseG$109.18$21.84
0750Dolasetron mesylateK$6.55$1.31
0763Dolasetron mesylate oralK$48.54$9.71
0764Granisetron HCl injectionK$7.24$1.45
0765Granisetron HCl oralK$33.51$6.70
0768Ondansetron hcl injectionK$3.80$0.76
0769Ondansetron hcl oralK$32.02$6.40
0800Leuprolide acetateK$441.78$88.36
0802Etoposide oralK$41.12$8.22
0807Aldesleukin/single use vialK$701.76$140.35
0809Bcg live intravesical vacK$121.74$24.35
0810Goserelin acetate implantK$196.25$39.25
0811Carboplatin injectionK$77.16$15.43
0812Carmus bischl nitro injK$141.29$28.26
0814Asparaginase injectionK$55.42$11.08
0819Dacarbazine injK$6.20$1.24
0820DaunorubicinK$35.28$7.06
0821Daunorubicin citrate liposomK$57.56$11.51
0823DocetaxelK$301.17$60.23
0827Floxuridine injectionK$60.17$12.03
0828Gemcitabine HCLK$117.45$23.49
0830Irinotecan injectionK$129.08$25.82
0831Ifosfomide injectionK$53.54$10.71
0832Idarubicin hcl injectionK$314.00$62.80
0834Interferon alfa-2a injK$31.75$6.35
0835Inj cosyntropinK$69.27$13.85
0836Interferon alfa-2b inj recombinant, 1 millionK$13.22$2.64
0838Interferon gamma 1-b injK$277.79$55.56
0840Melphalan hydrochlK$523.22$104.64
0842Fludarabine phosphate injK$262.41$52.48
0843PegaspargaseK$1,528.80$305.76
0844Pentostatin injectionK$1,868.91$373.78
0849RituximabK$447.97$89.59
0850Streptozocin injectionK$153.33$30.67
0851Thiotepa injectionK$44.55$8.91
0852TopotecanK$755.51$151.10
0855Vinorelbine tartrateK$62.85$12.57
0856Porfimer sodiumK$2,457.97$491.59
0857Bleomycin sulfate injectionK$54.18$10.84
0858CladribineK$39.37$7.87
0860Plicamycin (mithramycin) injK$80.54$16.11
0861Leuprolide acetate injectionK$10.96$2.19
0862MitomycinK$26.36$5.27
0863Paclitaxel injectionK$19.11$3.82
0864Mitoxantrone hclK$329.69$65.94
0865Interferon alfa-n3 inj, human leukocyte derived, 2K$8.77$1.75
0868Oral aprepitantG$4.75$0.95
0869IVIG lyophil 1gK$39.46$7.89
0870IVIG lyophil 10 mgK$0.40$0.08
0871IVIG non-lyophil 1gK$57.26$11.45
0872IVIG non-lyophil 10 mgK$0.57$0.11
0876Caffeine citrate injectionK$3.34$0.67
0880Penicillin g benzathine injK$72.26$14.45
0884Rho d immune globulin injK$113.91$22.78
0887Azathioprine parenteralK$47.40$9.48
0888Cyclosporine oralK$3.94$0.79
0890Lymphocyte immune globulinK$290.30$58.06
0891Tacrolimus oralK$3.37$0.67
0892Edetate calcium disodium injK$40.34$8.07
0893Calcitonin salmon injectionK$35.68$7.14
0895Deferoxamine mesylate injK$14.91$2.98
0900Alglucerase injectionK$39.94$7.99
0901Alpha 1 proteinase inhibitorK$3.30$0.66
0902Botulinum toxin a, per unitK$4.80$0.96
0903Cytomegalovirus imm IV/vialK$683.07$136.61
Start Printed Page 50691
0906RSV-ivigK$15.56$3.11
0910Interferon beta-1bK$81.95$16.39
0911StreptokinaseK$83.36$16.67
0912Interferon alfacon-1K$3.91$0.78
0913Ganciclovir long act implantK$4,318.68$863.74
0916Injection imiglucerase /unitK$3.98$0.80
0917Adenosine injectionK$71.53$14.31
0925Factor viiiK$0.51$0.10
0926Factor VIII (porcine)K$1.75$0.35
0927Factor viii recombinantK$0.94$0.19
0928Factor ix complexK$0.52$0.10
0929Anti-inhibitor per iuK$1.12$0.22
0931Factor IX non-recombinantK$0.75$0.15
0932Factor IX recombinantK$0.86$0.17
0935Clonidine hydrochlorideK$57.47$11.49
0949Plasma, Pooled Multiple Donor, Solvent/Detergent TK1.1956$70.95$14.19
0950Blood (Whole) For TransfusionK2.0123$119.42$23.88
0952CryoprecipitateK0.7395$43.88$8.78
0954RBC leukocytes reducedK2.7370$162.42$32.48
0955Plasma, Fresh FrozenK1.2934$76.75$15.35
0956Plasma Protein FractionK1.1226$66.62$13.32
0957Platelet ConcentrateK0.8317$49.36$9.87
0958Platelet Rich PlasmaK5.1815$307.49$61.50
0959Red Blood CellsK2.0301$120.47$24.09
0960Washed Red Blood CellsK2.9707$176.29$35.26
0961Infusion, Albumin (Human) 5%, 50 mlK0.5119$30.38$6.08
0963Albumin (human), 5%K1.3869$82.30$16.46
0964Albumin (human), 25%K0.4878$28.95$5.79
0965Albumin (human), 25%K1.1117$65.97$13.19
0966Plasmaprotein fract, 5%K4.9564$294.13$58.83
0967Split unit of bloodK1.2698$75.35$15.07
0968Platelets leukocyte reduced irradiatedK2.3639$140.28$28.06
0969Red blood cell leukocyte reduced irradiatedK3.6451$216.31$43.26
1009Cryoprecip reduced plasmaK1.3062$77.51$15.50
1010Blood, L/R, CMV-negK2.9692$176.20$35.24
1011Platelets, HLA-m, L/R, unitK10.9690$650.93$130.19
1013Platelet concentrate, L/R, unitK1.6023$95.09$19.02
1016Blood, L/R, froz/deglycerol/washedK5.2631$312.33$62.47
1017Platelets, aph/pher, L/R, CMV-neg, unitK8.5998$510.34$102.07
1018Blood, L/R, irradiatedK2.8004$166.18$33.24
1019Platelets, aph/pher, L/R, irradiated, unitK9.5131$564.54$112.91
1020Pit, pher, L/R, CMV, irradK10.1551$602.63$120.53
1021RBC, frz/deg/wsh, L/R, irradK4.8787$289.52$57.90
1022RBC, L/R, CMV neg, irradK4.2901$254.59$50.92
1045Iobenguane sulfate I-131H
1052Injection, VoriconazoleK$4.63$0.93
1064I-131 sodium iodide capsuleH
1065I-131 sodium iodide solutionH
1080I-131 tositumomab, dxH
1081I-131 tositumomab, txH
1082TreprostinilK$55.02$11.00
1083Injection, AdalimumabK$300.10$60.02
1084Denileukin diftitoxK$1,235.33$247.07
1085Injection, Gallium NitrateK$1.30$0.26
1086Temozolomide,oralK$7.28$1.46
1088Dx I131 so iodide cap millicH
1091IN 111 OxyquinolineH
1092IN 111 PentetateH
1093TC99M fanolesomabH
1096TC 99M Exametazime, per doseH
1150Th I131 so iodide sol millicH
1166Cytarabine liposomeK$366.43$73.29
1167Epirubicin hclK$25.15$5.03
1178Busulfan IVK0.2851$16.92$3.38
1201TC 99M SUCCIMER, PER VialH
1203Verteporfin for injectionK$9.16$1.83
1207Octreotide injection, depotK$87.40$17.48
1210Inj dihydroergotamine mesyltK$27.82$5.56
1280Corticotropin injectionK$95.44$19.09
Start Printed Page 50692
1305ApligrafK12.9222$766.84$153.37
1330Ergonovine maleate injectionK0.5263$31.23$6.25
1409Factor viia recombinantK$1,080.11$216.02
1436Etidronate disodium injK$68.69$13.74
1491New Technology—Level I ($0-$10)S$5.00$1.00
1492New Technology—Level I ($10-$20)S$15.00$3.00
1493New Technology—Level I ($20-$30)S$25.00$5.00
1494New Technology—Level I ($30-$40)S$35.00$7.00
1495New Technology—Level I ($40-$50)S$45.00$9.00
1496New Technology—Level I ($0-$10)T$5.00$1.00
1497New Technology—Level I ($10-$20)T$15.00$3.00
1498New Technology—Level I ($20-$30)T$25.00$5.00
1499New Technology—Level I ($30-$40)T$35.00$7.00
1500New Technology—Level I ($40-$50)T$45.00$9.00
1502New Technology—Level II ($50-$100)S$75.00$15.00
1503New Technology—Level III ($100-$200)S$150.00$30.00
1504New Technology—Level IV ($200-$300)S$250.00$50.00
1505New Technology—Level V ($300-$400)S$350.00$70.00
1506New Technology—Level VI ($400-$500)S$450.00$90.00
1507New Technology—Level VII ($500-$600)S$550.00$110.00
1508New Technology—Level VIII ($600-$700)S$650.00$130.00
1509New Technology—Level IX ($700-$800)S$750.00$150.00
1510New Technology—Level X ($800-$900)S$850.00$170.00
1511New Technology—Level XI ($900-$1000)S$950.00$190.00
1512New Technology—Level XII ($1000-$1100)S$1,050.00$210.00
1513New Technology—Level XIII ($1100-$1200)S$1,150.00$230.00
1514New Technology—Level XIV ($1200-$1300)S$1,250.00$250.00
1515New Technology—Level XV ($1300-$1400)S$1,350.00$270.00
1516New Technology—Level XVI ($1400-$1500)S$1,450.00$290.00
1517New Technology—Level XVII ($1500-$1600)S$1,550.00$310.00
1518New Technology—Level XVIII ($1600-$1700)S$1,650.00$330.00
1519New Technology—Level IXX ($1700-$1800)S$1,750.00$350.00
1520New Technology—Level XX ($1800-$1900)S$1,850.00$370.00
1521New Technology—Level XXI ($1900-$2000)S$1,950.00$390.00
1522New Technology—Level XXII ($2000-$2500)S$2,250.00$450.00
1523New Technology—Level XXIII ($2500-$3000)S$2,750.00$550.00
1524New Technology—Level XIV ($3000-$3500)S$3,250.00$650.00
1525New Technology—Level XXV ($3500-$4000)S$3,750.00$750.00
1526New Technology—Level XXVI ($4000-$4500)S$4,250.00$850.00
1527New Technology—Level XXVII ($4500-$5000)S$4,750.00$950.00
1528New Technology—Level XXVIII ($5000-$5500)S$5,250.00$1,050.00
1529New Technology—Level XXIX ($5500-$6000)S$5,750.00$1,150.00
1530New Technology—Level XXX ($6000-$6500)S$6,250.00$1,250.00
1531New Technology—Level XXXI ($6500-$7000)S$6,750.00$1,350.00
1532New Technology—Level XXXII ($7000-$7500)S$7,250.00$1,450.00
1533New Technology—Level XXXIII ($7500-$8000)S$7,750.00$1,550.00
1534New Technology—Level XXXIV ($8000-$8500)S$8,250.00$1,650.00
1535New Technology—Level XXXV ($8500-$9000)S$8,750.00$1,750.00
1536New Technology—Level XXXVI ($9000-$9500)S$9,250.00$1,850.00
1537New Technology—Level XXXVII ($9500-$10000)S$9,750.00$1,950.00
1539New Technology—Level II ($50-$100)T$75.00$15.00
1540New Technology—Level III ($100-$200)T$150.00$30.00
1541New Technology—Level IV ($200-$300)T$250.00$50.00
1542New Technology—Level V ($300-$400)T$350.00$70.00
1543New Technology—Level VI ($400-$500)T$450.00$90.00
1544New Technology—Level VII ($500-$600)T$550.00$110.00
1545New Technology—Level VIII ($600-$700)T$650.00$130.00
1546New Technology—Level IX ($700-$800)T$750.00$150.00
1547New Technology—Level X ($800-$900)T$850.00$170.00
1548New Technology—Level XI ($900-$1000)T$950.00$190.00
1549New Technology—Level XII ($1000-$1100)T$1,050.00$210.00
1550New Technology—Level XIII ($1100-$1200)T$1,150.00$230.00
1551New Technology—Level XIV ($1200- $1300)T$1,250.00$250.00
1552New Technology—Level XV ($1300-$1400)T$1,350.00$270.00
1553New Technology—Level XVI ($1400-$1500)T$1,450.00$290.00
1554New Technology—Level XVII ($1500-$1600)T$1,550.00$310.00
1555New Technology—Level XVIII ($1600-$1700)T$1,650.00$330.00
1556New Technology—Level XIX ($1700-$1800)T$1,750.00$350.00
1557New Technology—Level XX ($1800-$1900)T$1,850.00$370.00
Start Printed Page 50693
1558New Technology—Level XXI ($1900-$2000)T$1,950.00$390.00
1559New Technology—Level XXII ($2000-$2500)T$2,250.00$450.00
1560New Technology—Level XXIII ($2500-$3000)T$2,750.00$550.00
1561New Technology—Level XXIV ($3000-$3500)T$3,250.00$650.00
1562New Technology—Level XXV ($3500-$4000)T$3,750.00$750.00
1563New Technology—Level XXVI ($4000-$4500)T$4,250.00$850.00
1564New Technology—Level XXVII ($4500-$5000)T$4,750.00$950.00
1565New Technology—Level XXVIII ($5000-$5500)T$5,250.00$1,050.00
1566New Technology—Level XXIX ($5500-$6000)T$5,750.00$1,150.00
1567New Technology—Level XXX ($6000-$6500)T$6,250.00$1,250.00
1568New Technology—Level XXXI ($6500-$7000)T$6,750.00$1,350.00
1569New Technology—Level XXXII ($7000-$7500)T$7,250.00$1,450.00
1570New Technology—Level XXXIII ($7500-$8000)T$7,750.00$1,550.00
1571New Technology—Level XXXIV ($8000-$8500)T$8,250.00$1,650.00
1572New Technology—Level XXXV ($8500-$9000)T$8,750.00$1,750.00
1573New Technology—Level XXXVI ($9000-$9500)T$9,250.00$1,850.00
1574New Technology—Level XXXVII ($9500-$10000)T$9,750.00$1,950.00
1600Technetium TC 99m sestamibiH
1603Thallous chloride TL 201H
1604IN 111 capromab pendetide, per doseH
1605Abciximab injectionK$450.60$90.12
1607Eptifibatide injectionK$12.73$2.55
1608Etanercept injectionK$152.11$30.42
1609Rho(D) immune globulin h, sdK$12.04$2.41
1611Hylan G-F 20 injectionK$203.15$40.63
1612Daclizumab, parenteralK$381.48$76.30
1613TrastuzumabK$53.98$10.80
1615BasiliximabK$1,473.57$294.71
1618Vonwillebrandfactrcmplx, per iuK$0.74$0.15
1619Gallium ga 67H
1620Technetium tc99m bicisateH
1622Technetium tc99m mertiatideH
1624Sodium phosphate p32H
1625Indium 111-in pentetreotideH
1628Chromic phosphate p32H
1655Tinzaparin sodium injectionK$2.53$0.51
1670Tetanus immune globulin injK$76.90$15.38
1716Brachytx source, Gold 198H
1717Brachytx source, HDR Ir-192H
1718Brachytx source, Iodine 125H
1719Brachytx sour, Non-HDR Ir-192H
1720Brachytx sour, Palladium 103H
1740Diazoxide injectionK$113.86$22.77
1775FDG, per dose (4-40 mCi/ml)H
2210Methyldopate hcl injectionK$9.58$1.92
2616Brachytx source, Yttrium-90H
2632Brachytx sol, I-125, per mCiH
2633Brachytx source, Cesium-131H
2634Brachytx source, HA, I-125H
2635Brachytx source, HA, P-103H
2636Brachytx linear source, P-103H
2730Pralidoxime chloride injK$76.68$15.34
2770Quinupristin/dalfopristinK$105.48$21.10
2940Somatrem injectionK$43.14$8.63
3030Sumatriptan succinateK$51.03$10.21
7000AmifostineK$436.01$87.20
7005Gonadorelin hydrochK$173.44$34.69
7011Oprelvekin injectionK$249.06$49.81
7015Busulfan, oralK$1.98$0.40
7019AprotininK$2.20$0.44
7024Corticorelin ovine triflutatK$386.53$77.31
7025Digoxin immune FAB (ovine)K$552.18$110.44
7026Ethanolamine oleateK$64.53$12.91
7027FomepizoleK$12.31$2.46
7028FosphenytoinK$5.19$1.04
7030HeminK$6.51$1.30
7034Somatropin injectionK$42.93$8.59
7035TeniposideK$266.23$53.25
7036Urokinase injK$415.69$83.14
Start Printed Page 50694
7037UrofollitropinK$44.74$8.95
7038Monoclonal antibodiesK$885.36$177.07
7040Pentastarch 10% solutionK$12.45$2.49
7041Tirofiban hclK$7.89$1.58
7042Capecitabine, oralK$3.30$0.66
7043Infliximab injectionK$54.20$10.84
7045Trimetrexate glucoronateK$139.85$27.97
7046Doxorubicin hcl liposome injK$365.64$73.13
7048Alteplase recombinantK$30.65$6.13
7049Filgrastim injectionK$282.29$56.46
7051Leuprolide acetate implantK$2,262.19$452.44
7308Aminolevulinic acid hcl topK$96.79$19.36
7316Sodium hyaluronate injectionK$110.65$22.13
7515Cyclosporine oralK$1.00$0.20
9001Linezolid injectionK$24.15$4.83
9002TenecteplaseK$2,052.77$410.55
9003PalivizumabK4.1491$246.22$49.24
9004Gemtuzumab ozogamicinK$2,245.04$449.01
9005Reteplase injectionK$898.81$179.76
9006Tacrolimus injectionK$126.61$25.32
9008Baclofen Refill Kit-500mcgK0.2447$14.52$2.90
9009Baclofen refill kit—per 2000 mcgK0.7209$42.78$8.56
9012Arsenic TrioxideK$33.76$6.75
9015Mycophenolate mofetil oralK$2.50$0.50
9018Botulinum toxin BK$7.89$1.58
9019Caspofungin acetateK$32.35$6.47
9020Sirolimus tabletK$6.85$1.37
9022IM inj interferon beta 1-aK$89.10$17.82
9023Rho d immune globulinK$25.08$5.02
9024Amphotericin b lipid complexK$11.95$2.39
9025Rubidium-Rb-82H
9030Amphotericin BK$30.70$6.14
9031Arbutamine HCl injectionK$163.15$32.63
9032Baclofen 10 MG injectionK$188.01$37.60
9033Cidofovir injectionK$782.98$156.60
9038Inj estrogen conjugateK$57.77$11.55
9040Intraocular Fomivirsen naK$203.93$40.79
9042Glucagon hydrochlorideK$62.16$12.43
9044Ibutilide fumarate injectionK$243.34$48.67
9045Iron dextranK$11.43$2.29
9046Iron sucrose injectionK$0.38$0.08
9047Itraconazole injectionK$36.93$7.39
9051Urea injectionK1.0454$62.04$12.41
9054Metabolically active tissueK$15.69$3.14
9055Injectable human tissueK$3.54$0.71
9057LepirudinK$128.17$25.63
9100Iodinated I-131 serumalbumin, per 5uciH
9104Anti-thymocycte globulin rabbitK$299.47$59.89
9105Hep B imm globK1.8813$111.64$22.33
9108Thyrotropin alfaK$712.58$142.52
9110Alemtuzumab injectionK$516.87$103.37
9112Inj Perflutren lipid micros, mlK$63.51$12.70
9114NesiritideK$75.19$15.04
9115Inj, zoledronic acidK$202.41$40.48
9117Yttrium 90 ibritumomab tiuxetanH
9118In-111 ibritumomab tiuxetanH
9119PegfilgrastimK$2,178.28$435.66
9120Inj, FulvestrantK$82.90$16.58
9121Inj, ArgatrobanK0.1897$11.26$2.25
9122Triptorelin pamoateK$369.98$74.00
9123TranscyteK$719.41$143.88
9124Injection, daptomycinG$0.30$0.06
9125Risperidone, long actingG$4.71$0.94
9126Injection, natalizumabG$6.51$1.30
9127Paclitaxel protein prK$8.59$1.72
9128Inj pegaptanib sodiumK$1,074.27$214.85
9130Na chromateCr51, per 0.25mCiH
913251 Na Chromate, 50mCiH
9133Rabies ig, im/scK$64.56$12.91
Start Printed Page 50695
9134Rabies ig, heat treatedK$69.79$13.96
9135Varicella-zoster ig, imK$96.58$19.32
9136Adenovirus vaccine, type 4K0.9499$56.37$11.27
9137Bcg vaccine, percutK$124.54$24.91
9138Hep a/hep b vacc, adult imK0.9674$57.41$11.48
9139Rabies vaccine, imK$128.04$25.61
9140Rabies vaccine, idK1.4959$88.77$17.75
9141Measles-rubella vaccine, scK0.9467$56.18$11.24
9142Chicken pox vaccine, scK$64.29$12.86
9143Meningococcal vaccine, scK$56.75$11.35
9144Encephalitis vaccine, scK$67.73$13.55
9145Meningococcal vaccine, imK0.8948$53.10$10.62
9146Technetium TC99m DisofeninH
9147Technetium TC 99M DepreotideH
9148I-123 sodium iodide capsuleH
9149Dx I131 so iodide microcurieH
9150I-125 serum albumin microH
9151Tc 99M ARCITUMOMAB PER VIALH
9152Baclofen Intrathecal kit-1amK0.8562$50.81$10.16
9153Na Iothalamate I-125, 10 uCiH
9154Technetium tc99m glucepatateH
9155Technetium tc99mlabeledrbcsH
9156Nonmetabolic active tissueK$53.76$10.75
9157LOCM <=149 mg/ml iodineK$0.51$0.10
9158LOCM 150-199mg/ml iodineK$2.00$0.40
9159LOCM 200-249mg/ml iodineK$0.78$0.16
9160LOCM 250-299mg/ml iodineK$0.66$0.13
9161LOCM 300-349mg/ml iodineK$0.41$0.08
9162LOCM 350-399mg/ml iodineK$0.27$0.05
9163LOCM >= 400 mg/ml iodineK$0.20$0.04
9164Inj Gad-base MR contrastK$3.01$0.60
9165Oral MR contrastK$9.01$1.80
9166Dyphylline injectionK$7.74$1.55
9167ValrubicinK$376.87$75.37
9168Pegademase bovineK$161.16$32.23
9169Anthrax vaccine, scK$128.95$25.79
9200OrcelK2.6893$159.59$31.92
9201DermagraftK6.2066$368.32$73.66
9202Inj Octafluoropropane mic,mlK$41.42$8.28
9203Inj Perflexane lipid micros, mlK$13.49$2.70
9205OxaliplatinK$84.06$16.81
9206IntegraK$9.23$1.85
9207Injection, bortezomibK$28.90$5.78
9208Injection, agalsidase betaK$123.35$24.67
9209Injection, laronidaseK$23.16$4.63
9210Injection, palonosetron HCLK18.42$3.68
9211Inj, alefacept, IVK$571.01$114.20
9212Inj, alefacept, IMK$402.00$80.40
9213Injection, PemetrexedG$41.29$8.26
9214Injection, BevacizumabG$58.17$11.63
9215Injection, CetuximabG$50.59$10.12
9216Abarelix InjectionG$66.96$13.39
9217Leuprolide acetate suspnsionK$230.87$46.17
9218Injection, AzacitidineK$4.03$0.81
9219Mycophenolic AcidG$2.47$0.49
9220Sodium hyaluronateG$203.84$40.77
9221Graftjacket Reg MatrixG$1,234.36$246.87
9222Graftjacket SftTisG$890.74$178.15
9300Injection, OmalizumabG$15.98$3.20
9500Platelets, irradiatedK1.3589$80.64$16.13
9501Platelets, pheresis, leukocytes reducedK8.1495$483.62$96.72
9502Platelet pheresis irradiatedK5.1895$307.96$61.59
9503Fresh frozen plasma, ea unitK1.6241$96.38$19.28
9504RBC deglycerolizedK6.4314$381.66$76.33
9505RBC irradiatedK2.3876$141.69$28.34
9506Granulocytes, pheresisK15.6155$926.67$185.33
9507Platelets, pheresisK6.8988$409.40$81.88
9508Plasma, frozen w/in 8 hoursK1.2038$71.44$14.29
Start Printed Page 50696

6. On pages 42776-42965, Addendum B is corrected to read as follows:

—————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved.

Addendum B.—Payment Status by HCPCS Code and Related Information Calendar Year 2006

CPT/HCPCSSICIDescriptionAPCRelative weightPayment rateNational unadjusted copaymentMinimum unadjusted copayment
0003TSCervicography1492$15.00$3.00
0008TTUpper gi endoscopy w/suture042222.9647$1,362.79$448.81$272.56
00100NAnesth, salivary gland
00102NAnesth, repair of cleft lip
00103NAnesth, blepharoplasty
00104NAnesth, electroshock
0010TATb test, gamma interferon
00120NAnesth, ear surgery
00124NAnesth, ear exam
00126NAnesth, tympanotomy
00140NAnesth, procedures on eye
00142NAnesth, lens surgery
00144NAnesth, corneal transplant
00145NAnesth, vitreoretinal surg
00147NAnesth, iridectomy
00148NAnesth, eye exam
00160NAnesth, nose/sinus surgery
00162NAnesth, nose/sinus surgery
00164NAnesth, biopsy of nose
0016TTThermotx choroid vasc lesion02354.6593$276.50$67.40$55.30
00170NAnesth, procedure on mouth
00172NAnesth, cleft palate repair
00174NAnesth, pharyngeal surgery
00176CAnesth, pharyngeal surgery
0017TEPhotocoagulat macular drusen
0018TSTranscranial magnetic stimul02150.6115$36.29$14.51$7.26
00190NAnesth, face/skull bone surg
00192CAnesth, facial bone surgery
0019TEExtracorp shock wave tx, ms
0020TBExtracorp shock wave tx, ft
00210NAnesth, open head surgery
00212NAnesth, skull drainage
00214CAnesth, skull drainage
00215CAnesth, skull repair/fract
00216NAnesth, head vessel surgery
00218NAnesth, special head surgery
0021TCFetal oximetry, trnsvag/cerv
00220NAnesth, intrcrn nerve
00222NAnesth, head nerve surgery
0023TAPhenotype drug test, hiv 1
0024TCTranscath cardiac reduction
0026TAMeasure remnant lipoproteins
0027TTEndoscopic epidural lysis022017.3586$1,030.11$206.02
0028TNDexa body composition study
0029TAMagnetic tx for incontinence
00300NAnesth, head/neck/ptrunk
0030TAAntiprothrombin antibody
0031TNSpeculoscopy
00320NAnesth, neck organ, 1 & over
00322NAnesth, biopsy of thyroid
00326NAnesth, larynx/trach, < 1 yr
0032TNSpeculoscopy w/direct sample
0033TCEndovasc taa repr incl subcl
0034TCEndovasc taa repr w/o subcl
00350NAnesth, neck vessel surgery
00352NAnesth, neck vessel surgery
0035TCInsert endovasc prosth, taa
0036TCEndovasc prosth, taa, add-on
0037TCArtery transpose/endovas taa
0038TCRad endovasc taa rpr w/cover
0039TCRad s/i, endovasc taa repair
00400NAnesth, skin, ext/per/atrunk
Start Printed Page 50697
00402NAnesth, surgery of breast
00404CAnesth, surgery of breast
00406CAnesth, surgery of breast
0040TCRad s/i, endovasc taa prosth
00410NAnesth, correct heart rhythm
0041TADetect ur infect agnt w/cpas
0042TNCt perfusion w/contrast, cbf
0043TACo expired gas analysis
0044TNWhole body photography
00450NAnesth, surgery of shoulder
00452CAnesth, surgery of shoulder
00454NAnesth, collar bone biopsy
0045TNWhole body photography
0046TTCath lavage, mammary duct(s)002114.9776$888.82$219.48$177.76
00470NAnesth, removal of rib
00472NAnesth, chest wall repair
00474CAnesth, surgery of rib(s)
0047TTCath lavage, mammary duct(s)002114.9776$888.82$219.48$177.76
0048TCImplant ventricular device
0049TCExternal circulation assist
00500NAnesth, esophageal surgery
0050TCRemoval circulation assist
0051TCImplant total heart system
00520NAnesth, chest procedure
00522NAnesth, chest lining biopsy
00524CAnesth, chest drainage
00528NAnesth, chest partition view
00529NAnesth, chest partition view
0052TCReplace component heart syst
00530NAnesth, pacemaker insertion
00532NAnesth, vascular access
00534NAnesth, cardioverter/defib
00537NAnesth, cardiac electrophys
00539NAnesth, trach-bronch reconst
0053TCReplace component heart syst
00540CAnesth, chest surgery
00541NAnesth, one lung ventilation
00542CAnesth, release of lung
00546CAnesth, lung,chest wall surg
00548NAnesth, trachea,bronchi surg
0054TBBone surgery using computer
00550NAnesth, sternal debridement
0055TBBone surgery using computer
00560CAnesth, open heart surgery
00561CAnesth, heart surg < age 1
00562CAnesth, open heart surgery
00563NAnesth, heart proc w/pump
00566NAnesth, cabg w/o pump
0056TBBone surgery using computer
00580CAnesth, heart/lung transplnt
0058TXCryopreservation, ovary tiss03480.7927$47.04$9.41
0059TXCryopreservation, oocyte03480.7927$47.04$9.41
00600NAnesth, spine, cord surgery
00604CAnesth, sitting procedure
0060TBElectrical impedance scan
0061TBDestruction of tumor, breast
00620NAnesth, spine, cord surgery
00622CAnesth, removal of nerves
0062TTRep intradisc annulus1 lev020310.4015$617.26$246.90$123.45
00630NAnesth, spine, cord surgery
00632CAnesth, removal of nerves
00634NAnesth for chemonucleolysis
00635NAnesth, lumbar puncture
0063TTRep intradisc annulus>1lev020310.4015$617.26$246.90$123.45
00640NAnesth, spine manipulation
0064TASpectroscop eval expired gas
Start Printed Page 50698
0065TAOcular photoscreen bilat
0066TECt colonography screen
00670CAnesth, spine, cord surgery
0067T*SCt colonography dx03335.2836$313.54$125.41$62.71
0068TBInterp/rept heart sound
0069TNAnalysis only heart sound
00700NAnesth, abdominal wall surg
00702NAnesth, for liver biopsy
0070TNInterp only heart sound
0071TTU/s leiomyomata ablate <200019314.5843$865.48$173.10
0072TTU/s leiomyomata ablate >200019314.5843$865.48$173.10
00730NAnesth, abdominal wall surg
0073TSDelivery, comp imrt04125.3643$318.33$63.67
00740NAnesth, upper gi visualize
0074TEOnline physician e/m
00750NAnesth, repair of hernia
00752NAnesth, repair of hernia
00754NAnesth, repair of hernia
00756NAnesth, repair of hernia
0075TCPerq stent/chest vert art
0076TCS&i stent/chest vert art
00770NAnesth, blood vessel repair
0077TCCereb therm perfusion probe
0078TCEndovasc aort repr w/device
00790NAnesth, surg upper abdomen
00792CAnesth, hemorr/excise liver
00794CAnesth, pancreas removal
00796CAnesth, for liver transplant
00797NAnesth, surgery for obesity
0079TCEndovasc visc extnsn repr
00800NAnesth, abdominal wall surg
00802CAnesth, fat layer removal
0080TCEndovasc aort repr rad s&i
00810NAnesth, low intestine scope
0081TCEndovasc visc extnsn s&i
00820NAnesth, abdominal wall surg
0082TBStereotactic rad delivery
00830NAnesth, repair of hernia
00832NAnesth, repair of hernia
00834NAnesth, hernia repair< 1 yr
00836NAnesth hernia repair preemie
0083TNStereotactic rad tx mngmt
00840NAnesth, surg lower abdomen
00842NAnesth, amniocentesis
00844CAnesth, pelvis surgery
00846CAnesth, hysterectomy
00848CAnesth, pelvic organ surg
0084TTTemp prostate urethral stent01641.1855$70.35$17.29$14.07
00851NAnesth, tubal ligation
0085TXBreath test heart reject03400.6384$37.88$7.58
00860NAnesth, surgery of abdomen
00862NAnesth, kidney/ureter surg
00864CAnesth, removal of bladder
00865CAnesth, removal of prostate
00866CAnesth, removal of adrenal
00868CAnesth, kidney transplant
0086TNL ventricle fill pressure
00870NAnesth, bladder stone surg
00872NAnesth kidney stone destruct
00873NAnesth kidney stone destruct
0087TXSperm eval hyaluronan03480.7927$47.04$9.41
00880NAnesth, abdomen vessel surg
00882CAnesth, major vein ligation
0088TTRf tongue base vol reduxn025316.1357$957.54$282.29$191.51
00902NAnesth, anorectal surgery
00904CAnesth, perineal surgery
Start Printed Page 50699
00906NAnesth, removal of vulva
00908CAnesth, removal of prostate
00910NAnesth, bladder surgery
00912NAnesth, bladder tumor surg
00914NAnesth, removal of prostate
00916NAnesth, bleeding control
00918NAnesth, stone removal
00920NAnesth, genitalia surgery
00921NAnesth, vasectomy
00922NAnesth, sperm duct surgery
00924NAnesth, testis exploration
00926NAnesth, removal of testis
00928NAnesth, removal of testis
00930NAnesth, testis suspension
00932CAnesth, amputation of penis
00934CAnesth, penis, nodes removal
00936CAnesth, penis, nodes removal
00938NAnesth, insert penis device
00940NAnesth, vaginal procedures
00942NAnesth, surg on vag/urethral
00944CAnesth, vaginal hysterectomy
00948NAnesth, repair of cervix
00950NAnesth, vaginal endoscopy
00952NAnesth, hysteroscope/graph
01112NAnesth, bone aspirate/bx
01120NAnesth, pelvis surgery
01130NAnesth, body cast procedure
01140CAnesth, amputation at pelvis
01150CAnesth, pelvic tumor surgery
01160NAnesth, pelvis procedure
01170NAnesth, pelvis surgery
01173NAnesth, fx repair, pelvis
01180NAnesth, pelvis nerve removal
01190NAnesth, pelvis nerve removal
01200NAnesth, hip joint procedure
01202NAnesth, arthroscopy of hip
01210NAnesth, hip joint surgery
01212CAnesth, hip disarticulation
01214CAnesth, hip arthroplasty
01215NAnesth, revise hip repair
01220NAnesth, procedure on femur
01230NAnesth, surgery of femur
01232CAnesth, amputation of femur
01234CAnesth, radical femur surg
01250NAnesth, upper leg surgery
01260NAnesth, upper leg veins surg
01270NAnesth, thigh arteries surg
01272CAnesth, femoral artery surg
01274CAnesth, femoral embolectomy
01320NAnesth, knee area surgery
01340NAnesth, knee area procedure
01360NAnesth, knee area surgery
01380NAnesth, knee joint procedure
01382NAnesth, dx knee arthroscopy
01390NAnesth, knee area procedure
01392NAnesth, knee area surgery
01400NAnesth, knee joint surgery
01402CAnesth, knee arthroplasty
01404CAnesth, amputation at knee
01420NAnesth, knee joint casting
01430NAnesth, knee veins surgery
01432NAnesth, knee vessel surg
01440NAnesth, knee arteries surg
01442CAnesth, knee artery surg
01444CAnesth, knee artery repair
01462NAnesth, lower leg procedure
Start Printed Page 50700
01464NAnesth, ankle/ft arthroscopy
01470NAnesth, lower leg surgery
01472NAnesth, achilles tendon surg
01474NAnesth, lower leg surgery
01480NAnesth, lower leg bone surg
01482NAnesth, radical leg surgery
01484NAnesth, lower leg revision
01486CAnesth, ankle replacement
01490NAnesth, lower leg casting
01500NAnesth, leg arteries surg
01502CAnesth, lwr leg embolectomy
01520NAnesth, lower leg vein surg
01522NAnesth, lower leg vein surg
01610NAnesth, surgery of shoulder
01620NAnesth, shoulder procedure
01622NAnes dx shoulder arthroscopy
01630NAnesth, surgery of shoulder
01632CAnesth, surgery of shoulder
01634CAnesth, shoulder joint amput
01636CAnesth, forequarter amput
01638CAnesth, shoulder replacement
01650NAnesth, shoulder artery surg
01652CAnesth, shoulder vessel surg
01654CAnesth, shoulder vessel surg
01656CAnesth, arm-leg vessel surg
01670NAnesth, shoulder vein surg
01680NAnesth, shoulder casting
01682NAnesth, airplane cast
01710NAnesth, elbow area surgery
01712NAnesth, uppr arm tendon surg
01714NAnesth, uppr arm tendon surg
01716NAnesth, biceps tendon repair
01730NAnesth, uppr arm procedure
01732NAnesth, dx elbow arthroscopy
01740NAnesth, upper arm surgery
01742NAnesth, humerus surgery
01744NAnesth, humerus repair
01756CAnesth, radical humerus surg
01758NAnesth, humeral lesion surg
01760NAnesth, elbow replacement
01770NAnesth, uppr arm artery surg
01772NAnesth, uppr arm embolectomy
01780NAnesth, upper arm vein surg
01782NAnesth, uppr arm vein repair
01810NAnesth, lower arm surgery
01820NAnesth, lower arm procedure
01829NAnesth, dx wrist arthroscopy
01830NAnesth, lower arm surgery
01832NAnesth, wrist replacement
01840NAnesth, lwr arm artery surg
01842NAnesth, lwr arm embolectomy
01844NAnesth, vascular shunt surg
01850NAnesth, lower arm vein surg
01852NAnesth, lwr arm vein repair
01860NAnesth, lower arm casting
01905NAnes, spine inject, x-ray/re
01916NAnesth, dx arteriography
01920NAnesth, catheterize heart
01922NAnesth, cat or MRI scan
01924NAnes, ther interven rad, art
01925NAnes, ther interven rad, car
01926NAnes, tx interv rad hrt/cran
01930NAnes, ther interven rad, vei
01931NAnes, ther interven rad, tip
01932NAnes, tx interv rad, th vein
01933NAnes, tx interv rad, cran v
Start Printed Page 50701
01951NAnesth, burn, less 4 percent
01952NAnesth, burn, 4-9 percent
01953NAnesth, burn, each 9 percent
01958NAnesth, antepartum manipul
01960NAnesth, vaginal delivery
01961NAnesth, cs delivery
01962NAnesth, emer hysterectomy
01963NAnesth, cs hysterectomy
01964NAnesth, abortion procedures
01967NAnesth/analg, vag delivery
01968NAnes/analg cs deliver add-on
01969NAnesth/analg cs hyst add-on
01990CSupport for organ donor
01991NAnesth, nerve block/inj
01992NAnesth, n block/inj, prone
01995NRegional anesthesia limb
01996NHosp manage cont drug admin
01999NUnlisted anesth procedure
0500FEInitial prenatal care visit
0501FEPrenatal flow sheet
0502FESubsequent prenatal care
0503FEPostpartum care visit
1000FETobacco use, smoking, assess
1001FETobacco use, non-smoking
10021TFna w/o image00020.9559$56.73$11.35
10022TFna w/image00362.1773$129.21$25.84
1002FEAssess anginal symptom/level
10040TAcne surgery00100.5719$33.94$9.65$6.79
10060TDrainage of skin abscess00061.55$91.98$22.28$18.40
10061TDrainage of skin abscess00061.55$91.98$22.28$18.40
10080TDrainage of pilonidal cyst00061.55$91.98$22.28$18.40
10081TDrainage of pilonidal cyst000711.4501$679.48$135.90
10120TRemove foreign body00061.55$91.98$22.28$18.40
10121TRemove foreign body002114.9776$888.82$219.48$177.76
10140TDrainage of hematoma/fluid000711.4501$679.48$135.90
10160TPuncture drainage of lesion00181.1726$69.59$16.04$13.92
10180TComplex drainage, wound000816.4989$979.09$195.82
11000TDebride infected skin00151.6514$98.00$20.29$19.60
11001TDebride infected skin add-on00120.8497$50.42$11.18$10.08
11004CDebride genitalia & perineum
11005CDebride abdom wall
11006CDebride genit/per/abdom wall
11008CRemove mesh from abd wall
11010TDebride skin, fx00194.0547$240.62$71.87$48.12
11011TDebride skin/muscle, fx00194.0547$240.62$71.87$48.12
11012TDebride skin/muscle/bone, fx00194.0547$240.62$71.87$48.12
11040TDebride skin, partial00151.6514$98.00$20.29$19.60
11041TDebride skin, full00151.6514$98.00$20.29$19.60
11042TDebride skin/tissue00162.5834$153.31$33.57$30.66
11043TDebride tissue/muscle00162.5834$153.31$33.57$30.66
11044TDebride tissue/muscle/bone06826.9107$410.10$162.42$82.02
11055TTrim skin lesion00120.8497$50.42$11.18$10.08
11056TTrim skin lesions, 2 to 400120.8497$50.42$11.18$10.08
11057TTrim skin lesions, over 400131.1078$65.74$14.20$13.15
11100TBiopsy, skin lesion00181.1726$69.59$16.04$13.92
11101TBiopsy, skin add-on00181.1726$69.59$16.04$13.92
11200TRemoval of skin tags00131.1078$65.74$14.20$13.15
11201TRemove skin tags add-on00151.6514$98.00$20.29$19.60
11300TShave skin lesion00120.8497$50.42$11.18$10.08
11301TShave skin lesion00120.8497$50.42$11.18$10.08
11302TShave skin lesion00131.1078$65.74$14.20$13.15
11303TShave skin lesion00151.6514$98.00$20.29$19.60
11305TShave skin lesion00131.1078$65.74$14.20$13.15
11306TShave skin lesion00131.1078$65.74$14.20$13.15
11307TShave skin lesion00131.1078$65.74$14.20$13.15
11308TShave skin lesion00131.1078$65.74$14.20$13.15
Start Printed Page 50702
11310TShave skin lesion00131.1078$65.74$14.20$13.15
11311TShave skin lesion00131.1078$65.74$14.20$13.15
11312TShave skin lesion00131.1078$65.74$14.20$13.15
11313TShave skin lesion00162.5834$153.31$33.57$30.66
11400TRemoval of skin lesion00194.0547$240.62$71.87$48.12
11401TRemoval of skin lesion00194.0547$240.62$71.87$48.12
11402TRemoval of skin lesion00194.0547$240.62$71.87$48.12
11403TRemoval of skin lesion00206.9433$412.04$107.40$82.41
11404TRemoval of skin lesion002114.9776$888.82$219.48$177.76
11406TRemoval of skin lesion002114.9776$888.82$219.48$177.76
11420TRemoval of skin lesion00206.9433$412.04$107.40$82.41
11421TRemoval of skin lesion00206.9433$412.04$107.40$82.41
11422TRemoval of skin lesion00206.9433$412.04$107.40$82.41
11423TRemoval of skin lesion002114.9776$888.82$219.48$177.76
11424TRemoval of skin lesion002114.9776$888.82$219.48$177.76
11426TRemoval of skin lesion002219.6472$1,165.92$354.45$233.18
11440TRemoval of skin lesion00194.0547$240.62$71.87$48.12
11441TRemoval of skin lesion00194.0547$240.62$71.87$48.12
11442TRemoval of skin lesion00206.9433$412.04$107.40$82.41
11443TRemoval of skin lesion00206.9433$412.04$107.40$82.41
11444TRemoval of skin lesion00206.9433$412.04$107.40$82.41
11446TRemoval of skin lesion002219.6472$1,165.92$354.45$233.18
11450TRemoval, sweat gland lesion002219.6472$1,165.92$354.45$233.18
11451TRemoval, sweat gland lesion002219.6472$1,165.92$354.45$233.18
11462TRemoval, sweat gland lesion002219.6472$1,165.92$354.45$233.18
11463TRemoval, sweat gland lesion002219.6472$1,165.92$354.45$233.18
11470TRemoval, sweat gland lesion002219.6472$1,165.92$354.45$233.18
11471TRemoval, sweat gland lesion002219.6472$1,165.92$354.45$233.18
11600TRemoval of skin lesion00194.0547$240.62$71.87$48.12
11601TRemoval of skin lesion00194.0547$240.62$71.87$48.12
11602TRemoval of skin lesion00194.0547$240.62$71.87$48.12
11603TRemoval of skin lesion00206.9433$412.04$107.40$82.41
11604TRemoval of skin lesion00206.9433$412.04$107.40$82.41
11606TRemoval of skin lesion002114.9776$888.82$219.48$177.76
11620TRemoval of skin lesion00206.9433$412.04$107.40$82.41
11621TRemoval of skin lesion00194.0547$240.62$71.87$48.12
11622TRemoval of skin lesion00206.9433$412.04$107.40$82.41
11623TRemoval of skin lesion002114.9776$888.82$219.48$177.76
11624TRemoval of skin lesion002114.9776$888.82$219.48$177.76
11626TRemoval of skin lesion002219.6472$1,165.92$354.45$233.18
11640TRemoval of skin lesion00206.9433$412.04$107.40$82.41
11641TRemoval of skin lesion00206.9433$412.04$107.40$82.41
11642TRemoval of skin lesion00206.9433$412.04$107.40$82.41
11643TRemoval of skin lesion00206.9433$412.04$107.40$82.41
11644TRemoval of skin lesion002114.9776$888.82$219.48$177.76
11646TRemoval of skin lesion002219.6472$1,165.92$354.45$233.18
11719TTrim nail(s)00090.668$39.64$8.34$7.93
11720TDebride nail, 1-500090.668$39.64$8.34$7.93
11721TDebride nail, 6 or more00090.668$39.64$8.34$7.93
11730TRemoval of nail plate00131.1078$65.74$14.20$13.15
11732TRemove nail plate, add-on00120.8497$50.42$11.18$10.08
11740TDrain blood from under nail00090.668$39.64$8.34$7.93
11750TRemoval of nail bed00194.0547$240.62$71.87$48.12
11752TRemove nail bed/finger tip002219.6472$1,165.92$354.45$233.18
11755TBiopsy, nail unit00194.0547$240.62$71.87$48.12
11760TRepair of nail bed00241.6084$95.45$31.25$19.09
11762TReconstruction of nail bed00241.6084$95.45$31.25$19.09
11765TExcision of nail fold, toe00151.6514$98.00$20.29$19.60
11770TRemoval of pilonidal lesion002219.6472$1,165.92$354.45$233.18
11771TRemoval of pilonidal lesion002219.6472$1,165.92$354.45$233.18
11772TRemoval of pilonidal lesion002219.6472$1,165.92$354.45$233.18
11900TInjection into skin lesions00120.8497$50.42$11.18$10.08
11901TAdded skin lesions injection00120.8497$50.42$11.18$10.08
11920TCorrect skin color defects00241.6084$95.45$31.25$19.09
11921TCorrect skin color defects00241.6084$95.45$31.25$19.09
11922TCorrect skin color defects00241.6084$95.45$31.25$19.09
Start Printed Page 50703
11950TTherapy for contour defects00241.6084$95.45$31.25$19.09
11951TTherapy for contour defects00241.6084$95.45$31.25$19.09
11952TTherapy for contour defects00241.6084$95.45$31.25$19.09
11954TTherapy for contour defects00241.6084$95.45$31.25$19.09
11960TInsert tissue expander(s)002718.4182$1,092.99$329.72$218.60
11970TReplace tissue expander002718.4182$1,092.99$329.72$218.60
11971TRemove tissue expander(s)002219.6472$1,165.92$354.45$233.18
11975EInsert contraceptive cap
11976TRemoval of contraceptive cap00194.0547$240.62$71.87$48.12
11977ERemoval/reinsert contra cap
11980XImplant hormone pellet(s)03400.6384$37.88$7.58
11981XInsert drug implant device03400.6384$37.88$7.58
11982XRemove drug implant device03400.6384$37.88$7.58
11983XRemove/insert drug implant03400.6384$37.88$7.58
12001TRepair superficial wound(s)00241.6084$95.45$31.25$19.09
12002TRepair superficial wound(s)00241.6084$95.45$31.25$19.09
12004TRepair superficial wound(s)00241.6084$95.45$31.25$19.09
12005TRepair superficial wound(s)00241.6084$95.45$31.25$19.09
12006TRepair superficial wound(s)00241.6084$95.45$31.25$19.09
12007TRepair superficial wound(s)00241.6084$95.45$31.25$19.09
12011TRepair superficial wound(s)00241.6084$95.45$31.25$19.09
12013TRepair superficial wound(s)00241.6084$95.45$31.25$19.09
12014TRepair superficial wound(s)00241.6084$95.45$31.25$19.09
12015TRepair superficial wound(s)00241.6084$95.45$31.25$19.09
12016TRepair superficial wound(s)00241.6084$95.45$31.25$19.09
12017TRepair superficial wound(s)00241.6084$95.45$31.25$19.09
12018TRepair superficial wound(s)00241.6084$95.45$31.25$19.09
12020TClosure of split wound00241.6084$95.45$31.25$19.09
12021TClosure of split wound00241.6084$95.45$31.25$19.09
12031TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
12032TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
12034TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
12035TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
12036TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
12037TLayer closure of wound(s)00255.4938$326.02$101.85$65.20
12041TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
12042TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
12044TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
12045TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
12046TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
12047TLayer closure of wound(s)00255.4938$326.02$101.85$65.20
12051TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
12052TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
12053TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
12054TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
12055TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
12056TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
12057TLayer closure of wound(s)00255.4938$326.02$101.85$65.20
13100TRepair of wound or lesion00255.4938$326.02$101.85$65.20
13101TRepair of wound or lesion00255.4938$326.02$101.85$65.20
13102TRepair wound/lesion add-on00241.6084$95.45$31.25$19.09
13120TRepair of wound or lesion00241.6084$95.45$31.25$19.09
13121TRepair of wound or lesion00241.6084$95.45$31.25$19.09
13122TRepair wound/lesion add-on00241.6084$95.45$31.25$19.09
13131TRepair of wound or lesion00241.6084$95.45$31.25$19.09
13132TRepair of wound or lesion00241.6084$95.45$31.25$19.09
13133TRepair wound/lesion add-on00241.6084$95.45$31.25$19.09
13150TRepair of wound or lesion00255.4938$326.02$101.85$65.20
13151TRepair of wound or lesion00241.6084$95.45$31.25$19.09
13152TRepair of wound or lesion00255.4938$326.02$101.85$65.20
13153TRepair wound/lesion add-on00241.6084$95.45$31.25$19.09
13160TLate closure of wound002718.4182$1,092.99$329.72$218.60
14000TSkin tissue rearrangement068613.8287$820.64$164.13
14001TSkin tissue rearrangement002718.4182$1,092.99$329.72$218.60
14020TSkin tissue rearrangement068613.8287$820.64$164.13
14021TSkin tissue rearrangement002718.4182$1,092.99$329.72$218.60
Start Printed Page 50704
14040TSkin tissue rearrangement068613.8287$820.64$164.13
14041TSkin tissue rearrangement002718.4182$1,092.99$329.72$218.60
14060TSkin tissue rearrangement002718.4182$1,092.99$329.72$218.60
14061TSkin tissue rearrangement068613.8287$820.64$164.13
14300TSkin tissue rearrangement002718.4182$1,092.99$329.72$218.60
14350TSkin tissue rearrangement002718.4182$1,092.99$329.72$218.60
15000TSkin graft00255.4938$326.02$101.85$65.20
15001TSkin graft add-on00255.4938$326.02$101.85$65.20
15050TSkin pinch graft00255.4938$326.02$101.85$65.20
15100TSkin split graft002718.4182$1,092.99$329.72$218.60
15101TSkin split graft add-on002718.4182$1,092.99$329.72$218.60
15120TSkin split graft002718.4182$1,092.99$329.72$218.60
15121TSkin split graft add-on002718.4182$1,092.99$329.72$218.60
15200TSkin full graft002718.4182$1,092.99$329.72$218.60
15201TSkin full graft add-on00255.4938$326.02$101.85$65.20
15220TSkin full graft002718.4182$1,092.99$329.72$218.60
15221TSkin full graft add-on00255.4938$326.02$101.85$65.20
15240TSkin full graft068613.8287$820.64$164.13
15241TSkin full graft add-on00255.4938$326.02$101.85$65.20
15260TSkin full graft068613.8287$820.64$164.13
15261TSkin full graft add-on00255.4938$326.02$101.85$65.20
15342TCultured skin graft, 25 cm00241.6084$95.45$31.25$19.09
15343TCulture skn graft addl 25 cm00241.6084$95.45$31.25$19.09
15350TSkin homograft068613.8287$820.64$164.13
15351TSkin homograft add-on068613.8287$820.64$164.13
15400TSkin heterograft00255.4938$326.02$101.85$65.20
15401TSkin heterograft add-on00255.4938$326.02$101.85$65.20
15570TForm skin pedicle flap002718.4182$1,092.99$329.72$218.60
15572TForm skin pedicle flap002718.4182$1,092.99$329.72$218.60
15574TForm skin pedicle flap002718.4182$1,092.99$329.72$218.60
15576TForm skin pedicle flap068613.8287$820.64$164.13
15600TSkin graft002718.4182$1,092.99$329.72$218.60
15610TSkin graft002718.4182$1,092.99$329.72$218.60
15620TSkin graft002718.4182$1,092.99$329.72$218.60
15630TSkin graft002718.4182$1,092.99$329.72$218.60
15650TTransfer skin pedicle flap002718.4182$1,092.99$329.72$218.60
15732TMuscle-skin graft, head/neck002718.4182$1,092.99$329.72$218.60
15734TMuscle-skin graft, trunk002718.4182$1,092.99$329.72$218.60
15736TMuscle-skin graft, arm002718.4182$1,092.99$329.72$218.60
15738TMuscle-skin graft, leg002718.4182$1,092.99$329.72$218.60
15740TIsland pedicle flap graft068613.8287$820.64$164.13
15750TNeurovascular pedicle graft002718.4182$1,092.99$329.72$218.60
15756CFree muscle flap, microvasc
15757CFree skin flap, microvasc
15758CFree fascial flap, microvasc
15760TComposite skin graft002718.4182$1,092.99$329.72$218.60
15770TDerma-fat-fascia graft002718.4182$1,092.99$329.72$218.60
15775THair transplant punch grafts00255.4938$326.02$101.85$65.20
15776THair transplant punch grafts00255.4938$326.02$101.85$65.20
15780TAbrasion treatment of skin002219.6472$1,165.92$354.45$233.18
15781TAbrasion treatment of skin00194.0547$240.62$71.87$48.12
15782TDressing change not for burn00194.0547$240.62$71.87$48.12
15783TAbrasion treatment of skin00162.5834$153.31$33.57$30.66
15786TAbrasion, lesion, single00131.1078$65.74$14.20$13.15
15787TAbrasion, lesions, add-on00131.1078$65.74$14.20$13.15
15788TChemical peel, face, epiderm00120.8497$50.42$11.18$10.08
15789TChemical peel, face, dermal00151.6514$98.00$20.29$19.60
15792TChemical peel, nonfacial00131.1078$65.74$14.20$13.15
15793TChemical peel, nonfacial00120.8497$50.42$11.18$10.08
15810TSalabrasion00162.5834$153.31$33.57$30.66
15811TSalabrasion00162.5834$153.31$33.57$30.66
15819TPlastic surgery, neck00255.4938$326.02$101.85$65.20
15820TRevision of lower eyelid002718.4182$1,092.99$329.72$218.60
15821TRevision of lower eyelid002718.4182$1,092.99$329.72$218.60
15822TRevision of upper eyelid002718.4182$1,092.99$329.72$218.60
15823TRevision of upper eyelid002718.4182$1,092.99$329.72$218.60
Start Printed Page 50705
15824TRemoval of forehead wrinkles002718.4182$1,092.99$329.72$218.60
15825TRemoval of neck wrinkles002718.4182$1,092.99$329.72$218.60
15826TRemoval of brow wrinkles002718.4182$1,092.99$329.72$218.60
15828TRemoval of face wrinkles002718.4182$1,092.99$329.72$218.60
15829TRemoval of skin wrinkles002718.4182$1,092.99$329.72$218.60
15831TExcise excessive skin tissue002219.6472$1,165.92$354.45$233.18
15832TExcise excessive skin tissue002219.6472$1,165.92$354.45$233.18
15833TExcise excessive skin tissue002219.6472$1,165.92$354.45$233.18
15834TExcise excessive skin tissue002219.6472$1,165.92$354.45$233.18
15835TExcise excessive skin tissue00255.4938$326.02$101.85$65.20
15836TExcise excessive skin tissue002114.9776$888.82$219.48$177.76
15837TExcise excessive skin tissue002114.9776$888.82$219.48$177.76
15838TExcise excessive skin tissue002114.9776$888.82$219.48$177.76
15839TExcise excessive skin tissue002114.9776$888.82$219.48$177.76
15840TGraft for face nerve palsy002718.4182$1,092.99$329.72$218.60
15841TGraft for face nerve palsy002718.4182$1,092.99$329.72$218.60
15842TFlap for face nerve palsy002718.4182$1,092.99$329.72$218.60
15845TSkin and muscle repair, face002718.4182$1,092.99$329.72$218.60
15850TRemoval of sutures00162.5834$153.31$33.57$30.66
15851TRemoval of sutures00162.5834$153.31$33.57$30.66
15852XDressing change not for burn03400.6384$37.88$7.58
15860XTest for blood flow in graft03590.8312$49.33$9.87
15876TSuction assisted lipectomy002718.4182$1,092.99$329.72$218.60
15877TSuction assisted lipectomy002718.4182$1,092.99$329.72$218.60
15878TSuction assisted lipectomy068613.8287$820.64$164.13
15879TSuction assisted lipectomy002718.4182$1,092.99$329.72$218.60
15920TRemoval of tail bone ulcer00194.0547$240.62$71.87$48.12
15922TRemoval of tail bone ulcer002718.4182$1,092.99$329.72$218.60
15931TRemove sacrum pressure sore002219.6472$1,165.92$354.45$233.18
15933TRemove sacrum pressure sore002219.6472$1,165.92$354.45$233.18
15934TRemove sacrum pressure sore002718.4182$1,092.99$329.72$218.60
15935TRemove sacrum pressure sore002718.4182$1,092.99$329.72$218.60
15936TRemove sacrum pressure sore002718.4182$1,092.99$329.72$218.60
15937TRemove sacrum pressure sore002718.4182$1,092.99$329.72$218.60
15940TRemove hip pressure sore002219.6472$1,165.92$354.45$233.18
15941TRemove hip pressure sore002219.6472$1,165.92$354.45$233.18
15944TRemove hip pressure sore002718.4182$1,092.99$329.72$218.60
15945TRemove hip pressure sore002718.4182$1,092.99$329.72$218.60
15946TRemove hip pressure sore002718.4182$1,092.99$329.72$218.60
15950TRemove thigh pressure sore002219.6472$1,165.92$354.45$233.18
15951TRemove thigh pressure sore002219.6472$1,165.92$354.45$233.18
15952TRemove thigh pressure sore002718.4182$1,092.99$329.72$218.60
15953TRemove thigh pressure sore002718.4182$1,092.99$329.72$218.60
15956TRemove thigh pressure sore002718.4182$1,092.99$329.72$218.60
15958TRemove thigh pressure sore002718.4182$1,092.99$329.72$218.60
15999TRemoval of pressure sore00194.0547$240.62$71.87$48.12
16000TInitial treatment of burn(s)00120.8497$50.42$11.18$10.08
16010TTreatment of burn(s)00162.5834$153.31$33.57$30.66
16015TTreatment of burn(s)001718.4211$1,093.16$227.84$218.63
16020TTreatment of burn(s)00131.1078$65.74$14.20$13.15
16025TTreatment of burn(s)00131.1078$65.74$14.20$13.15
16030TTreatment of burn(s)00151.6514$98.00$20.29$19.60
16035CIncision of burn scab, initi
16036CEscharotomy addl incision
17000TDestroy benign/premlg lesion00100.5719$33.94$9.65$6.79
17003TDestroy lesions, 2-1400100.5719$33.94$9.65$6.79
17004TDestroy lesions, 15 or more00112.0839$123.66$25.17$24.73
17106TDestruction of skin lesions00112.0839$123.66$25.17$24.73
17107TDestruction of skin lesions00112.0839$123.66$25.17$24.73
17108TDestruction of skin lesions00112.0839$123.66$25.17$24.73
17110TDestruct lesion, 1-1400100.5719$33.94$9.65$6.79
17111TDestruct lesion, 15 or more00100.5719$33.94$9.65$6.79
17250TChemical cautery, tissue00131.1078$65.74$14.20$13.15
17260TDestruction of skin lesions00151.6514$98.00$20.29$19.60
17261TDestruction of skin lesions00151.6514$98.00$20.29$19.60
17262TDestruction of skin lesions00151.6514$98.00$20.29$19.60
Start Printed Page 50706
17263TDestruction of skin lesions00151.6514$98.00$20.29$19.60
17264TDestruction of skin lesions00151.6514$98.00$20.29$19.60
17266TDestruction of skin lesions00162.5834$153.31$33.57$30.66
17270TDestruction of skin lesions00151.6514$98.00$20.29$19.60
17271TDestruction of skin lesions00131.1078$65.74$14.20$13.15
17272TDestruction of skin lesions00151.6514$98.00$20.29$19.60
17273TDestruction of skin lesions00151.6514$98.00$20.29$19.60
17274TDestruction of skin lesions00162.5834$153.31$33.57$30.66
17276TDestruction of skin lesions00162.5834$153.31$33.57$30.66
17280TDestruction of skin lesions00151.6514$98.00$20.29$19.60
17281TDestruction of skin lesions00151.6514$98.00$20.29$19.60
17282TDestruction of skin lesions00151.6514$98.00$20.29$19.60
17283TDestruction of skin lesions00151.6514$98.00$20.29$19.60
17284TDestruction of skin lesions00162.5834$153.31$33.57$30.66
17286TDestruction of skin lesions00151.6514$98.00$20.29$19.60
17304TChemosurgery of skin lesion06943.8452$228.19$61.86$45.64
17305T2 stage mohs, up to 5 spec06943.8452$228.19$61.86$45.64
17306T3 stage mohs, up to 5 spec06943.8452$228.19$61.86$45.64
17307TMohs addl stage up to 5 spec06943.8452$228.19$61.86$45.64
17310TExtensive skin chemosurgery06943.8452$228.19$61.86$45.64
17340TCryotherapy of skin00120.8497$50.42$11.18$10.08
17360TSkin peel therapy00131.1078$65.74$14.20$13.15
17380THair removal by electrolysis00131.1078$65.74$14.20$13.15
17999TSkin tissue procedure00061.55$91.98$22.28$18.40
19000TDrainage of breast lesion00041.7646$104.72$22.36$20.94
19001TDrain breast lesion add-on00041.7646$104.72$22.36$20.94
19020TIncision of breast lesion000816.4989$979.09$195.82
19030NInjection for breast x-ray
19100TBx breast percut w/o image00053.5994$213.60$71.59$42.72
19101TBiopsy of breast, open002819.5801$1,161.94$303.74$232.39
19102TBx breast percut w/image00053.5994$213.60$71.59$42.72
19103TBx breast percut w/device06586.1049$362.28$72.46
19110Tnipple exploration002819.5801$1,161.94$303.74$232.39
19112TExcise breast duct fistula002819.5801$1,161.94$303.74$232.39
19120TRemoval of breast lesion002819.5801$1,161.94$303.74$232.39
19125TExcision, breast lesion002819.5801$1,161.94$303.74$232.39
19126TExcision, addl breast lesion002819.5801$1,161.94$303.74$232.39
19140TRemoval of breast tissue002819.5801$1,161.94$303.74$232.39
19160TRemoval of breast tissue002819.5801$1,161.94$303.74$232.39
19162TRemove breast tissue, nodes069342.2254$2,505.78$798.17$501.16
19180TRemoval of breast002932.0476$1,901.80$632.64$380.36
19182TRemoval of breast002932.0476$1,901.80$632.64$380.36
19200CRemoval of breast
19220CRemoval of breast
19240TRemoval of breast003040.0825$2,378.62$763.55$475.72
19260TRemoval of chest wall lesion002114.9776$888.82$219.48$177.76
19271CRevision of chest wall
19272CExtensive chest wall surgery
19290NPlace needle wire, breast
19291NPlace needle wire, breast
19295SPlace breast clip, percut06571.7092$101.43$20.29
19296SPlace po breast cath for rad1524$3,250.00$650.00
19297SPlace breast cath for rad1523$2,750.00$550.00
19298SPlace breast rad tube/caths1524$3,250.00$650.00
19316TSuspension of breast002932.0476$1,901.80$632.64$380.36
19318TReduction of large breast069342.2254$2,505.78$798.17$501.16
19324TEnlarge breast069342.2254$2,505.78$798.17$501.16
19325TEnlarge breast with implant064850.4459$2,993.61$598.72
19328TRemoval of breast implant002932.0476$1,901.80$632.64$380.36
19330TRemoval of implant material002932.0476$1,901.80$632.64$380.36
19340TImmediate breast prosthesis003040.0825$2,378.62$763.55$475.72
19342TDelayed breast prosthesis064850.4459$2,993.61$598.72
19350TBreast reconstruction002819.5801$1,161.94$303.74$232.39
19355TCorrect inverted nipple(s)002932.0476$1,901.80$632.64$380.36
19357TBreast reconstruction064850.4459$2,993.61$598.72
19361CBreast reconstruction
Start Printed Page 50707
19364CBreast reconstruction
19366TBreast reconstruction002932.0476$1,901.80$632.64$380.36
19367CBreast reconstruction
19368CBreast reconstruction
19369CBreast reconstruction
19370TSurgery of breast capsule002932.0476$1,901.80$632.64$380.36
19371TRemoval of breast capsule002932.0476$1,901.80$632.64$380.36
19380TRevise breast reconstruction003040.0825$2,378.62$763.55$475.72
19396TDesign custom breast implant002932.0476$1,901.80$632.64$380.36
19499TBreast surgery procedure002819.5801$1,161.94$303.74$232.39
20000TIncision of abscess00061.55$91.98$22.28$18.40
20005TIncision of deep abscess004920.3707$1,208.86$241.77
2000FEBlood pressure, measured
20100TExplore wound, neck00234.7775$283.51$56.70
20101TExplore wound, chest002718.4182$1,092.99$329.72$218.60
20102TExplore wound, abdomen002718.4182$1,092.99$329.72$218.60
20103TExplore wound, extremity00234.7775$283.51$56.70
20150TExcise epiphyseal bar005136.5271$2,167.63$433.53
20200TMuscle biopsy002114.9776$888.82$219.48$177.76
20205TDeep muscle biopsy002114.9776$888.82$219.48$177.76
20206TNeedle biopsy, muscle00053.5994$213.60$71.59$42.72
20220TBone biopsy, trocar/needle00194.0547$240.62$71.87$48.12
20225TBone biopsy, trocar/needle00206.9433$412.04$107.40$82.41
20240TBone biopsy, excisional002219.6472$1,165.92$354.45$233.18
20245TBone biopsy, excisional002219.6472$1,165.92$354.45$233.18
20250TOpen bone biopsy004920.3707$1,208.86$241.77
20251TOpen bone biopsy004920.3707$1,208.86$241.77
20500TInjection of sinus tract02512.0101$119.29$23.86
20501NInject sinus tract for x-ray
20520TRemoval of foreign body00194.0547$240.62$71.87$48.12
20525TRemoval of foreign body002219.6472$1,165.92$354.45$233.18
20526TTher injection, carp tunnel02042.191$130.02$40.13$26.00
20550TInject tendon/ligament/cyst02042.191$130.02$40.13$26.00
20551TInj tendon origin/insertion02042.191$130.02$40.13$26.00
20552TInj trigger point, 1/2 muscl02042.191$130.02$40.13$26.00
20553TInject trigger points, > 302042.191$130.02$40.13$26.00
20600TDrain/inject, joint/bursa02042.191$130.02$40.13$26.00
20605TDrain/inject, joint/bursa02042.191$130.02$40.13$26.00
20610TDrain/inject, joint/bursa02042.191$130.02$40.13$26.00
20612TAspirate/inj ganglion cyst02042.191$130.02$40.13$26.00
20615TTreatment of bone cyst00041.7646$104.72$22.36$20.94
20650TInsert and remove bone pin004920.3707$1,208.86$241.77
20660CApply, rem fixation device
20661CApplication of head brace
20662TApplication of pelvis brace004920.3707$1,208.86$241.77
20663TApplication of thigh brace004920.3707$1,208.86$241.77
20664CHalo brace application
20665XRemoval of fixation device03400.6384$37.88$7.58
20670TRemoval of support implant002114.9776$888.82$219.48$177.76
20680TRemoval of support implant002219.6472$1,165.92$354.45$233.18
20690TApply bone fixation device005023.9081$1,418.78$283.76
20692TApply bone fixation device005023.9081$1,418.78$283.76
20693TAdjust bone fixation device004920.3707$1,208.86$241.77
20694TRemove bone fixation device004920.3707$1,208.86$241.77
20802CReplantation, arm, complete
20805CReplant forearm, complete
20808CReplantation hand, complete
20816CReplantation digit, complete
20822TReplantation digit, complete005425.3711$1,505.60$301.12
20824CReplantation thumb, complete
20827CReplantation thumb, complete
20838CReplantation foot, complete
20900TRemoval of bone for graft005023.9081$1,418.78$283.76
20902TRemoval of bone for graft005023.9081$1,418.78$283.76
20910TRemove cartilage for graft002718.4182$1,092.99$329.72$218.60
20912TRemove cartilage for graft002718.4182$1,092.99$329.72$218.60
Start Printed Page 50708
20920TRemoval of fascia for graft068613.8287$820.64$164.13
20922TRemoval of fascia for graft002718.4182$1,092.99$329.72$218.60
20924TRemoval of tendon for graft005023.9081$1,418.78$283.76
20926TRemoval of tissue for graft068613.8287$820.64$164.13
20930CSpinal bone allograft
20931CSpinal bone allograft
20936CSpinal bone autograft
20937CSpinal bone autograft
20938CSpinal bone autograft
20950TFluid pressure, muscle00061.55$91.98$22.28$18.40
20955CFibula bone graft, microvasc
20956CIliac bone graft, microvasc
20957CMt bone graft, microvasc
20962COther bone graft, microvasc
20969CBone/skin graft, microvasc
20970CBone/skin graft, iliac crest
20972TBone/skin graft, metatarsal005640.2957$2,391.27$478.25
20973TBone/skin graft, great toe005640.2957$2,391.27$478.25
20974AElectrical bone stimulation
20975XElectrical bone stimulation03400.6384$37.88$7.58
20979AUs bone stimulation
20982TAblate, bone tumor(s) perq1557$1,850.00$370.00
20999TMusculoskeletal surgery004920.3707$1,208.86$241.77
21010TIncision of jaw joint025423.404$1,388.86$321.35$277.77
21015TResection of facial tumor025316.1357$957.54$282.29$191.51
21025TExcision of bone, lower jaw025637.3204$2,214.70$442.94
21026TExcision of facial bone(s)025637.3204$2,214.70$442.94
21029TContour of face bone lesion025637.3204$2,214.70$442.94
21030TRemoval of face bone lesion025423.404$1,388.86$321.35$277.77
21031TRemove exostosis, mandible025423.404$1,388.86$321.35$277.77
21032TRemove exostosis, maxilla025423.404$1,388.86$321.35$277.77
21034TRemoval of face bone lesion025637.3204$2,214.70$442.94
21040TRemoval of jaw bone lesion025423.404$1,388.86$321.35$277.77
21044TRemoval of jaw bone lesion025637.3204$2,214.70$442.94
21045CExtensive jaw surgery
21046TRemove mandible cyst complex025637.3204$2,214.70$442.94
21047TExcise lwr jaw cyst w/repair025637.3204$2,214.70$442.94
21048TRemove maxilla cyst complex025637.3204$2,214.70$442.94
21049TExcis uppr jaw cyst w/repair025637.3204$2,214.70$442.94
21050TRemoval of jaw joint025637.3204$2,214.70$442.94
21060TRemove jaw joint cartilage025637.3204$2,214.70$442.94
21070TRemove coronoid process025637.3204$2,214.70$442.94
21076TPrepare face/oral prosthesis025423.404$1,388.86$321.35$277.77
21077TPrepare face/oral prosthesis025637.3204$2,214.70$442.94
21079TPrepare face/oral prosthesis025637.3204$2,214.70$442.94
21080TPrepare face/oral prosthesis025637.3204$2,214.70$442.94
21081TPrepare face/oral prosthesis025637.3204$2,214.70$442.94
21082TPrepare face/oral prosthesis025637.3204$2,214.70$442.94
21083TPrepare face/oral prosthesis025637.3204$2,214.70$442.94
21084TPrepare face/oral prosthesis025637.3204$2,214.70$442.94
21085TPrepare face/oral prosthesis025316.1357$957.54$282.29$191.51
21086TPrepare face/oral prosthesis025637.3204$2,214.70$442.94
21087TPrepare face/oral prosthesis025637.3204$2,214.70$442.94
21088TPrepare face/oral prosthesis025637.3204$2,214.70$442.94
21089TPrepare face/oral prosthesis02512.0101$119.29$23.86
21100TMaxillofacial fixation025637.3204$2,214.70$442.94
21110TInterdental fixation02527.8673$466.87$113.41$93.37
21116NInjection, jaw joint x-ray
21120TReconstruction of chin025423.404$1,388.86$321.35$277.77
21121TReconstruction of chin025423.404$1,388.86$321.35$277.77
21122TReconstruction of chin025423.404$1,388.86$321.35$277.77
21123TReconstruction of chin025423.404$1,388.86$321.35$277.77
21125TAugmentation, lower jaw bone025423.404$1,388.86$321.35$277.77
21127TAugmentation, lower jaw bone025637.3204$2,214.70$442.94
21137TReduction of forehead025423.404$1,388.86$321.35$277.77
21138TReduction of forehead025637.3204$2,214.70$442.94
Start Printed Page 50709
21139TReduction of forehead025637.3204$2,214.70$442.94
21141CReconstruct midface, lefort
21142CReconstruct midface, lefort
21143CReconstruct midface, lefort
21145CReconstruct midface, lefort
21146CReconstruct midface, lefort
21147CReconstruct midface, lefort
21150TReconstruct midface, lefort025637.3204$2,214.70$442.94
21151CReconstruct midface, lefort
21154CReconstruct midface, lefort
21155CReconstruct midface, lefort
21159CReconstruct midface, lefort
21160CReconstruct midface, lefort
21172CReconstruct orbit/forehead
21175TReconstruct orbit/forehead025637.3204$2,214.70$442.94
21179CReconstruct entire forehead
21180CReconstruct entire forehead
21181TContour cranial bone lesion025423.404$1,388.86$321.35$277.77
21182CReconstruct cranial bone
21183CReconstruct cranial bone
21184CReconstruct cranial bone
21188CReconstruction of midface
21193CReconst lwr jaw w/o graft
21194CReconst lwr jaw w/graft
21195TReconst lwr jaw w/o fixation025637.3204$2,214.70$442.94
21196CReconst lwr jaw w/fixation
21198TReconstr lwr jaw segment025637.3204$2,214.70$442.94
21199TReconstr lwr jaw w/advance025637.3204$2,214.70$442.94
21206TReconstruct upper jaw bone025637.3204$2,214.70$442.94
21208TAugmentation of facial bones025637.3204$2,214.70$442.94
21209TReduction of facial bones025637.3204$2,214.70$442.94
21210TFace bone graft025637.3204$2,214.70$442.94
21215TLower jaw bone graft025637.3204$2,214.70$442.94
21230TRib cartilage graft025637.3204$2,214.70$442.94
21235TEar cartilage graft025423.404$1,388.86$321.35$277.77
21240TReconstruction of jaw joint025637.3204$2,214.70$442.94
21242TReconstruction of jaw joint025637.3204$2,214.70$442.94
21243TReconstruction of jaw joint025637.3204$2,214.70$442.94
21244TReconstruction of lower jaw025637.3204$2,214.70$442.94
21245TReconstruction of jaw025637.3204$2,214.70$442.94
21246TReconstruction of jaw025637.3204$2,214.70$442.94
21247CReconstruct lower jaw bone
21248TReconstruction of jaw025637.3204$2,214.70$442.94
21249TReconstruction of jaw025637.3204$2,214.70$442.94
21255CReconstruct lower jaw bone
21256CReconstruction of orbit
21260TRevise eye sockets025637.3204$2,214.70$442.94
21261TRevise eye sockets025637.3204$2,214.70$442.94
21263TRevise eye sockets025637.3204$2,214.70$442.94
21267TRevise eye sockets025637.3204$2,214.70$442.94
21268CRevise eye sockets
21270TAugmentation, cheek bone025637.3204$2,214.70$442.94
21275TRevision, orbitofacial bones025637.3204$2,214.70$442.94
21280TRevision of eyelid025637.3204$2,214.70$442.94
21282TRevision of eyelid025316.1357$957.54$282.29$191.51
21295TRevision of jaw muscle/bone02527.8673$466.87$113.41$93.37
21296TRevision of jaw muscle/bone025423.404$1,388.86$321.35$277.77
21299TCranio/maxillofacial surgery02512.0101$119.29$23.86
21300TTreatment of skull fracture025316.1357$957.54$282.29$191.51
21310TTreatment of nose fracture02512.0101$119.29$23.86
21315TTreatment of nose fracture02512.0101$119.29$23.86
21320TTreatment of nose fracture02527.8673$466.87$113.41$93.37
21325TTreatment of nose fracture025423.404$1,388.86$321.35$277.77
21330TTreatment of nose fracture025423.404$1,388.86$321.35$277.77
21335TTreatment of nose fracture025423.404$1,388.86$321.35$277.77
21336TTreat nasal septal fracture004637.7023$2,237.37$535.76$447.47
Start Printed Page 50710
21337TTreat nasal septal fracture025316.1357$957.54$282.29$191.51
21338TTreat nasoethmoid fracture025423.404$1,388.86$321.35$277.77
21339TTreat nasoethmoid fracture025423.404$1,388.86$321.35$277.77
21340TTreatment of nose fracture025637.3204$2,214.70$442.94
21343CTreatment of sinus fracture
21344CTreatment of sinus fracture
21345TTreat nose/jaw fracture025423.404$1,388.86$321.35$277.77
21346CTreat nose/jaw fracture
21347CTreat nose/jaw fracture
21348CTreat nose/jaw fracture
21355TTreat cheek bone fracture025637.3204$2,214.70$442.94
21356TTreat cheek bone fracture025423.404$1,388.86$321.35$277.77
21360CTreat cheek bone fracture
21365CTreat cheek bone fracture
21366CTreat cheek bone fracture
21385CTreat eye socket fracture
21386CTreat eye socket fracture
21387CTreat eye socket fracture
21390TTreat eye socket fracture025637.3204$2,214.70$442.94
21395CTreat eye socket fracture
21400TTreat eye socket fracture02527.8673$466.87$113.41$93.37
21401TTreat eye socket fracture025316.1357$957.54$282.29$191.51
21406TTreat eye socket fracture025637.3204$2,214.70$442.94
21407TTreat eye socket fracture025637.3204$2,214.70$442.94
21408TTreat eye socket fracture025637.3204$2,214.70$442.94
21421TTreat mouth roof fracture025423.404$1,388.86$321.35$277.77
21422CTreat mouth roof fracture
21423CTreat mouth roof fracture
21431CTreat craniofacial fracture
21432CTreat craniofacial fracture
21433CTreat craniofacial fracture
21435CTreat craniofacial fracture
21436CTreat craniofacial fracture
21440TTreat dental ridge fracture025423.404$1,388.86$321.35$277.77
21445TTreat dental ridge fracture025423.404$1,388.86$321.35$277.77
21450TTreat lower jaw fracture02512.0101$119.29$23.86
21451TTreat lower jaw fracture02527.8673$466.87$113.41$93.37
21452TTreat lower jaw fracture025316.1357$957.54$282.29$191.51
21453TTreat lower jaw fracture025637.3204$2,214.70$442.94
21454TTreat lower jaw fracture025423.404$1,388.86$321.35$277.77
21461TTreat lower jaw fracture025637.3204$2,214.70$442.94
21462TTreat lower jaw fracture025637.3204$2,214.70$442.94
21465TTreat lower jaw fracture025637.3204$2,214.70$442.94
21470TTreat lower jaw fracture025637.3204$2,214.70$442.94
21480TReset dislocated jaw02512.0101$119.29$23.86
21485TReset dislocated jaw025316.1357$957.54$282.29$191.51
21490TRepair dislocated jaw025637.3204$2,214.70$442.94
21493TTreat hyoid bone fracture02527.8673$466.87$113.41$93.37
21494TTreat hyoid bone fracture02527.8673$466.87$113.41$93.37
21495TTreat hyoid bone fracture025316.1357$957.54$282.29$191.51
21497TInterdental wiring025316.1357$957.54$282.29$191.51
21499THead surgery procedure02512.0101$119.29$23.86
21501TDrain neck/chest lesion000816.4989$979.09$195.82
21502TDrain chest lesion004920.3707$1,208.86$241.77
21510CDrainage of bone lesion
21550TBiopsy of neck/chest002114.9776$888.82$219.48$177.76
21555TRemove lesion, neck/chest002219.6472$1,165.92$354.45$233.18
21556TRemove lesion, neck/chest002219.6472$1,165.92$354.45$233.18
21557TRemove tumor, neck/chest002219.6472$1,165.92$354.45$233.18
21600TPartial removal of rib005023.9081$1,418.78$283.76
21610TPartial removal of rib005023.9081$1,418.78$283.76
21615CRemoval of rib
21616CRemoval of rib and nerves
21620CPartial removal of sternum
21627CSternal debridement
21630CExtensive sternum surgery
Start Printed Page 50711
21632CExtensive sternum surgery
21685THyoid myotomy & suspension02527.8673$466.87$113.41$93.37
21700TRevision of neck muscle004920.3707$1,208.86$241.77
21705CRevision of neck muscle/rib
21720TRevision of neck muscle004920.3707$1,208.86$241.77
21725TRevision of neck muscle00061.55$91.98$22.28$18.40
21740CReconstruction of sternum
21742TRepair stern/nuss w/o scope005136.5271$2,167.63$433.53
21743TRepair sternum/nuss w/scope005136.5271$2,167.63$433.53
21750CRepair of sternum separation
21800TTreatment of rib fracture00431.7694$105.00$21.00
21805TTreatment of rib fracture004637.7023$2,237.37$535.76$447.47
21810CTreatment of rib fracture(s)
21820TTreat sternum fracture00431.7694$105.00$21.00
21825CTreat sternum fracture
21899TNeck/chest surgery procedure02512.0101$119.29$23.86
21920TBiopsy soft tissue of back00206.9433$412.04$107.40$82.41
21925TBiopsy soft tissue of back002219.6472$1,165.92$354.45$233.18
21930TRemove lesion, back or flank002219.6472$1,165.92$354.45$233.18
21935TRemove tumor, back002219.6472$1,165.92$354.45$233.18
22100TRemove part of neck vertebra020842.3409$2,512.64$502.53
22101TRemove part, thorax vertebra020842.3409$2,512.64$502.53
22102TRemove part, lumbar vertebra020842.3409$2,512.64$502.53
22103TRemove extra spine segment020842.3409$2,512.64$502.53
22110CRemove part of neck vertebra
22112CRemove part, thorax vertebra
22114CRemove part, lumbar vertebra
22116CRemove extra spine segment
22210CRevision of neck spine
22212CRevision of thorax spine
22214CRevision of lumbar spine
22216CRevise, extra spine segment
22220CRevision of neck spine
22222TRevision of thorax spine020842.3409$2,512.64$502.53
22224CRevision of lumbar spine
22226CRevise, extra spine segment
22305TTreat spine process fracture00431.7694$105.00$21.00
22310TTreat spine fracture00431.7694$105.00$21.00
22315TTreat spine fracture00431.7694$105.00$21.00
22318CTreat odontoid fx w/o graft
22319CTreat odontoid fx w/graft
22325CTreat spine fracture
22326CTreat neck spine fracture
22327CTreat thorax spine fracture
22328CTreat each add spine fx
22505TManipulation of spine004514.4945$860.15$268.47$172.03
22520TPercut vertebroplasty thor005023.9081$1,418.78$283.76
22521TPercut vertebroplasty lumb005023.9081$1,418.78$283.76
22522TPercut vertebroplasty add'l005023.9081$1,418.78$283.76
22532CLat thorax spine fusion
22533CLat lumbar spine fusion
22534CLat thor/lumb, add'l seg
22548CNeck spine fusion
22554CNeck spine fusion
22556CThorax spine fusion
22558CLumbar spine fusion
22585CAdditional spinal fusion
22590CSpine & skull spinal fusion
22595CNeck spinal fusion
22600CNeck spine fusion
22610CThorax spine fusion
22612TLumbar spine fusion020842.3409$2,512.64$502.53
22614TSpine fusion, extra segment020842.3409$2,512.64$502.53
22630CLumbar spine fusion
22632CSpine fusion, extra segment
22800CFusion of spine
Start Printed Page 50712
22802CFusion of spine
22804CFusion of spine
22808CFusion of spine
22810CFusion of spine
22812CFusion of spine
22818CKyphectomy, 1-2 segments
22819CKyphectomy, 3 or more
22830CExploration of spinal fusion
22840CInsert spine fixation device
22841CInsert spine fixation device
22842CInsert spine fixation device
22843CInsert spine fixation device
22844CInsert spine fixation device
22845CInsert spine fixation device
22846CInsert spine fixation device
22847CInsert spine fixation device
22848CInsert pelv fixation device
22849CReinsert spinal fixation
22850CRemove spine fixation device
22851CApply spine prosth device
22852CRemove spine fixation device
22855CRemove spine fixation device
22899TSpine surgery procedure00431.7694$105.00$21.00
22900TRemove abdominal wall lesion002219.6472$1,165.92$354.45$233.18
22999TAbdomen surgery procedure00194.0547$240.62$71.87$48.12
23000TRemoval of calcium deposits002114.9776$888.82$219.48$177.76
23020TRelease shoulder joint005136.5271$2,167.63$433.53
23030TDrain shoulder lesion000816.4989$979.09$195.82
23031TDrain shoulder bursa000816.4989$979.09$195.82
23035TDrain shoulder bone lesion004920.3707$1,208.86$241.77
23040TExploratory shoulder surgery005023.9081$1,418.78$283.76
23044TExploratory shoulder surgery005023.9081$1,418.78$283.76
23065TBiopsy shoulder tissues002114.9776$888.82$219.48$177.76
23066TBiopsy shoulder tissues002219.6472$1,165.92$354.45$233.18
23075TRemoval of shoulder lesion002114.9776$888.82$219.48$177.76
23076TRemoval of shoulder lesion002219.6472$1,165.92$354.45$233.18
23077TRemove tumor of shoulder002219.6472$1,165.92$354.45$233.18
23100TBiopsy of shoulder joint004920.3707$1,208.86$241.77
23101TShoulder joint surgery005023.9081$1,418.78$283.76
23105TRemove shoulder joint lining005023.9081$1,418.78$283.76
23106TIncision of collarbone joint005023.9081$1,418.78$283.76
23107TExplore treat shoulder joint005023.9081$1,418.78$283.76
23120TPartial removal, collar bone005136.5271$2,167.63$433.53
23125TRemoval of collar bone005136.5271$2,167.63$433.53
23130TRemove shoulder bone, part005136.5271$2,167.63$433.53
23140TRemoval of bone lesion004920.3707$1,208.86$241.77
23145TRemoval of bone lesion005023.9081$1,418.78$283.76
23146TRemoval of bone lesion005023.9081$1,418.78$283.76
23150TRemoval of humerus lesion005023.9081$1,418.78$283.76
23155TRemoval of humerus lesion005023.9081$1,418.78$283.76
23156TRemoval of humerus lesion005023.9081$1,418.78$283.76
23170TRemove collar bone lesion005023.9081$1,418.78$283.76
23172TRemove shoulder blade lesion005023.9081$1,418.78$283.76
23174TRemove humerus lesion005023.9081$1,418.78$283.76
23180TRemove collar bone lesion005023.9081$1,418.78$283.76
23182TRemove shoulder blade lesion005023.9081$1,418.78$283.76
23184TRemove humerus lesion005023.9081$1,418.78$283.76
23190TPartial removal of scapula005023.9081$1,418.78$283.76
23195TRemoval of head of humerus005023.9081$1,418.78$283.76
23200CRemoval of collar bone
23210CRemoval of shoulder blade
23220CPartial removal of humerus
23221CPartial removal of humerus
23222CPartial removal of humerus
23330TRemove shoulder foreign body00206.9433$412.04$107.40$82.41
23331TRemove shoulder foreign body002219.6472$1,165.92$354.45$233.18
Start Printed Page 50713
23332CRemove shoulder foreign body
23350NInjection for shoulder x-ray
23395TMuscle transfer,shoulder/arm005136.5271$2,167.63$433.53
23397TMuscle transfers005243.9378$2,607.40$521.48
23400TFixation of shoulder blade005023.9081$1,418.78$283.76
23405TIncision of tendon & muscle005023.9081$1,418.78$283.76
23406TIncise tendon(s) & muscle(s)005023.9081$1,418.78$283.76
23410TRepair of tendon(s)005243.9378$2,607.40$521.48
23412TRepair rotator cuff, chronic005243.9378$2,607.40$521.48
23415TRelease of shoulder ligament005136.5271$2,167.63$433.53
23420TRepair of shoulder005243.9378$2,607.40$521.48
23430TRepair biceps tendon005243.9378$2,607.40$521.48
23440TRemove/transplant tendon005243.9378$2,607.40$521.48
23450TRepair shoulder capsule005243.9378$2,607.40$521.48
23455TRepair shoulder capsule005243.9378$2,607.40$521.48
23460TRepair shoulder capsule005243.9378$2,607.40$521.48
23462TRepair shoulder capsule005243.9378$2,607.40$521.48
23465TRepair shoulder capsule005243.9378$2,607.40$521.48
23466TRepair shoulder capsule005243.9378$2,607.40$521.48
23470TReconstruct shoulder joint0425100.2058$5,946.51$1,378.01$1,189.30
23472CReconstruct shoulder joint
23480TRevision of collar bone005136.5271$2,167.63$433.53
23485TRevision of collar bone005136.5271$2,167.63$433.53
23490TReinforce clavicle005136.5271$2,167.63$433.53
23491TReinforce shoulder bones005136.5271$2,167.63$433.53
23500TTreat clavicle fracture00431.7694$105.00$21.00
23505TTreat clavicle fracture00431.7694$105.00$21.00
23515TTreat clavicle fracture004637.7023$2,237.37$535.76$447.47
23520TTreat clavicle dislocation00431.7694$105.00$21.00
23525TTreat clavicle dislocation00431.7694$105.00$21.00
23530TTreat clavicle dislocation004637.7023$2,237.37$535.76$447.47
23532TTreat clavicle dislocation004637.7023$2,237.37$535.76$447.47
23540TTreat clavicle dislocation00431.7694$105.00$21.00
23545TTreat clavicle dislocation00431.7694$105.00$21.00
23550TTreat clavicle dislocation004637.7023$2,237.37$535.76$447.47
23552TTreat clavicle dislocation004637.7023$2,237.37$535.76$447.47
23570TTreat shoulder blade fx00431.7694$105.00$21.00
23575TTreat shoulder blade fx00431.7694$105.00$21.00
23585TTreat scapula fracture004637.7023$2,237.37$535.76$447.47
23600TTreat humerus fracture00431.7694$105.00$21.00
23605TTreat humerus fracture00431.7694$105.00$21.00
23615TTreat humerus fracture004637.7023$2,237.37$535.76$447.47
23616TTreat humerus fracture004637.7023$2,237.37$535.76$447.47
23620TTreat humerus fracture00431.7694$105.00$21.00
23625TTreat humerus fracture00431.7694$105.00$21.00
23630TTreat humerus fracture004637.7023$2,237.37$535.76$447.47
23650TTreat shoulder dislocation00431.7694$105.00$21.00
23655TTreat shoulder dislocation004514.4945$860.15$268.47$172.03
23660TTreat shoulder dislocation004637.7023$2,237.37$535.76$447.47
23665TTreat dislocation/fracture00431.7694$105.00$21.00
23670TTreat dislocation/fracture004637.7023$2,237.37$535.76$447.47
23675TTreat dislocation/fracture00431.7694$105.00$21.00
23680TTreat dislocation/fracture004637.7023$2,237.37$535.76$447.47
23700TFixation of shoulder004514.4945$860.15$268.47$172.03
23800TFusion of shoulder joint005136.5271$2,167.63$433.53
23802TFusion of shoulder joint005136.5271$2,167.63$433.53
23900CAmputation of arm & girdle
23920CAmputation at shoulder joint
23921TAmputation follow-up surgery00255.4938$326.02$101.85$65.20
23929TShoulder surgery procedure00431.7694$105.00$21.00
23930TDrainage of arm lesion000816.4989$979.09$195.82
23931TDrainage of arm bursa000816.4989$979.09$195.82
23935TDrain arm/elbow bone lesion004920.3707$1,208.86$241.77
24000TExploratory elbow surgery005023.9081$1,418.78$283.76
24006TRelease elbow joint005023.9081$1,418.78$283.76
24065TBiopsy arm/elbow soft tissue002114.9776$888.82$219.48$177.76
Start Printed Page 50714
24066TBiopsy arm/elbow soft tissue002114.9776$888.82$219.48$177.76
24075TRemove arm/elbow lesion002114.9776$888.82$219.48$177.76
24076TRemove arm/elbow lesion002219.6472$1,165.92$354.45$233.18
24077TRemove tumor of arm/elbow002219.6472$1,165.92$354.45$233.18
24100TBiopsy elbow joint lining004920.3707$1,208.86$241.77
24101TExplore/treat elbow joint005023.9081$1,418.78$283.76
24102TRemove elbow joint lining005023.9081$1,418.78$283.76
24105TRemoval of elbow bursa004920.3707$1,208.86$241.77
24110TRemove humerus lesion004920.3707$1,208.86$241.77
24115TRemove/graft bone lesion005023.9081$1,418.78$283.76
24116TRemove/graft bone lesion005023.9081$1,418.78$283.76
24120TRemove elbow lesion004920.3707$1,208.86$241.77
24125TRemove/graft bone lesion005023.9081$1,418.78$283.76
24126TRemove/graft bone lesion005023.9081$1,418.78$283.76
24130TRemoval of head of radius005023.9081$1,418.78$283.76
24134TRemoval of arm bone lesion005023.9081$1,418.78$283.76
24136TRemove radius bone lesion005023.9081$1,418.78$283.76
24138TRemove elbow bone lesion005023.9081$1,418.78$283.76
24140TPartial removal of arm bone005023.9081$1,418.78$283.76
24145TPartial removal of radius005023.9081$1,418.78$283.76
24147TPartial removal of elbow005023.9081$1,418.78$283.76
24149TRadical resection of elbow005023.9081$1,418.78$283.76
24150TExtensive humerus surgery005243.9378$2,607.40$521.48
24151TExtensive humerus surgery005243.9378$2,607.40$521.48
24152TExtensive radius surgery005243.9378$2,607.40$521.48
24153TExtensive radius surgery005243.9378$2,607.40$521.48
24155TRemoval of elbow joint005136.5271$2,167.63$433.53
24160TRemove elbow joint implant005023.9081$1,418.78$283.76
24164TRemove radius head implant005023.9081$1,418.78$283.76
24200TRemoval of arm foreign body00194.0547$240.62$71.87$48.12
24201TRemoval of arm foreign body002114.9776$888.82$219.48$177.76
24220NInjection for elbow x-ray
24300TManipulate elbow w/anesth004514.4945$860.15$268.47$172.03
24301TMuscle/tendon transfer005023.9081$1,418.78$283.76
24305TArm tendon lengthening005023.9081$1,418.78$283.76
24310TRevision of arm tendon004920.3707$1,208.86$241.77
24320TRepair of arm tendon005136.5271$2,167.63$433.53
24330TRevision of arm muscles005136.5271$2,167.63$433.53
24331TRevision of arm muscles005136.5271$2,167.63$433.53
24332TTenolysis, triceps004920.3707$1,208.86$241.77
24340TRepair of biceps tendon005136.5271$2,167.63$433.53
24341TRepair arm tendon/muscle005136.5271$2,167.63$433.53
24342TRepair of ruptured tendon005136.5271$2,167.63$433.53
24343TRepr elbow lat ligmnt w/tiss005023.9081$1,418.78$283.76
24344TReconstruct elbow lat ligmnt005136.5271$2,167.63$433.53
24345TRepr elbw med ligmnt w/tissu005023.9081$1,418.78$283.76
24346TReconstruct elbow med ligmnt005136.5271$2,167.63$433.53
24350TRepair of tennis elbow005023.9081$1,418.78$283.76
24351TRepair of tennis elbow005023.9081$1,418.78$283.76
24352TRepair of tennis elbow005023.9081$1,418.78$283.76
24354TRepair of tennis elbow005023.9081$1,418.78$283.76
24356TRevision of tennis elbow005023.9081$1,418.78$283.76
24360TReconstruct elbow joint004731.6107$1,875.87$537.03$375.17
24361TReconstruct elbow joint0425100.2058$5,946.51$1,378.01$1,189.30
24362TReconstruct elbow joint004843.1288$2,559.39$570.30$511.88
24363TReplace elbow joint0425100.2058$5,946.51$1,378.01$1,189.30
24365TReconstruct head of radius004731.6107$1,875.87$537.03$375.17
24366TReconstruct head of radius0425100.2058$5,946.51$1,378.01$1,189.30
24400TRevision of humerus005023.9081$1,418.78$283.76
24410TRevision of humerus005023.9081$1,418.78$283.76
24420TRevision of humerus005136.5271$2,167.63$433.53
24430TRepair of humerus005136.5271$2,167.63$433.53
24435TRepair humerus with graft005136.5271$2,167.63$433.53
24470TRevision of elbow joint005136.5271$2,167.63$433.53
24495TDecompression of forearm005023.9081$1,418.78$283.76
24498TReinforce humerus005136.5271$2,167.63$433.53
Start Printed Page 50715
24500TTreat humerus fracture00431.7694$105.00$21.00
24505TTreat humerus fracture00431.7694$105.00$21.00
24515TTreat humerus fracture004637.7023$2,237.37$535.76$447.47
24516TTreat humerus fracture004637.7023$2,237.37$535.76$447.47
24530TTreat humerus fracture00431.7694$105.00$21.00
24535TTreat humerus fracture00431.7694$105.00$21.00
24538TTreat humerus fracture004637.7023$2,237.37$535.76$447.47
24545TTreat humerus fracture004637.7023$2,237.37$535.76$447.47
24546TTreat humerus fracture004637.7023$2,237.37$535.76$447.47
24560TTreat humerus fracture00431.7694$105.00$21.00
24565TTreat humerus fracture00431.7694$105.00$21.00
24566TTreat humerus fracture004637.7023$2,237.37$535.76$447.47
24575TTreat humerus fracture004637.7023$2,237.37$535.76$447.47
24576TTreat humerus fracture00431.7694$105.00$21.00
24577TTreat humerus fracture00431.7694$105.00$21.00
24579TTreat humerus fracture004637.7023$2,237.37$535.76$447.47
24582TTreat humerus fracture004637.7023$2,237.37$535.76$447.47
24586TTreat elbow fracture004637.7023$2,237.37$535.76$447.47
24587TTreat elbow fracture004637.7023$2,237.37$535.76$447.47
24600TTreat elbow dislocation00431.7694$105.00$21.00
24605TTreat elbow dislocation004514.4945$860.15$268.47$172.03
24615TTreat elbow dislocation004637.7023$2,237.37$535.76$447.47
24620TTreat elbow fracture00431.7694$105.00$21.00
24635TTreat elbow fracture004637.7023$2,237.37$535.76$447.47
24640TTreat elbow dislocation00431.7694$105.00$21.00
24650TTreat radius fracture00431.7694$105.00$21.00
24655TTreat radius fracture00431.7694$105.00$21.00
24665TTreat radius fracture004637.7023$2,237.37$535.76$447.47
24666TTreat radius fracture004637.7023$2,237.37$535.76$447.47
24670TTreat ulnar fracture00431.7694$105.00$21.00
24675TTreat ulnar fracture00431.7694$105.00$21.00
24685TTreat ulnar fracture004637.7023$2,237.37$535.76$447.47
24800TFusion of elbow joint005136.5271$2,167.63$433.53
24802TFusion/graft of elbow joint005136.5271$2,167.63$433.53
24900CAmputation of upper arm
24920CAmputation of upper arm
24925TAmputation follow-up surgery004920.3707$1,208.86$241.77
24930CAmputation follow-up surgery
24931CAmputate upper arm & implant
24935T